I have been contacted by numerous people across County Tipperary regarding concerns about diabetic services in University Hospital Limerick, UHL. These concerns were highlighted in an article in The Irish Times, which concluded that diabetics in the mid-west region are offered a disgraceful service. There are 20,000 registered patients between counties Tipperary, Limerick and Clare. There are 225,000 people with diabetes in Ireland. Of this figure, between 10% and 15% have type 1 diabetes. People of any age can be diagnosed with type 1 diabetes, however, it is much more likely to be diagnosed in young people. Up to five children and teenagers are diagnosed with type 1 diabetes every week in Ireland. According to medical reports, the number of older people being diagnosed with the condition is steadily rising. Early intervention and specialised medical support structures are key to averting an influx of adult patients with type 1 diabetes.

In addition to being given the proper medication to treat and stabilise type 1 diabetes, the condition requires expert instruction on managing both the administration of insulin and the effective control of diet. In University Hospital Limerick, the needs of paediatric type 1 diabetics are being met by a specialist dietician. There is no specialist dietician in the hospital to attend to the needs of long-term or newly-diagnosed adult type 1 diabetic patients. If they are hospitalised, they can receive dietary advice and support from a ward dietician. There is no specialist care or outpatient appointments available for adult diabetics at University Hospital Limerick. This is not the quality of service we expect from a centre of excellence.

It is discriminatory and disgraceful that UHL does not provide pumps that deliver insulin subcutaneously 24 hours a day. These pumps offer diabetics the benefit of the latest technology. It is a simpler, and much less invasive, means of controlling the condition. These devices are efficient and effective and give the patient peace of mind and a release from regular injections.

In December 2020, UHL received confirmation of funding to recruit for three new additional dietetic posts for the treatment of adult diabetes. Nine months later, and those posts have not been filled. The HSE, in a typical bureaucratic flourish, tells us that the recruitment process for two of these posts is at an advanced stage, while the process for the third remains ongoing.

The UHL staff currently working with diabetics are providing exemplary care to patients. They are delivering a service under immense pressure. They need additional support.

Adults need and deserve access to dietary services and the provision of insulin pumps from UHL, which is deemed to be the centre of excellence for the Limerick, Clare and Tipperary area.

I thank Deputy Lowry for raising the issue the lack of insulin pumps and the recruitment of three additional dieticians, which was sanctioned nine months ago in UHL. I am advised that the University Limerick Hospitals Group recognises the need for additional resources within its adult diabetic service. This issue is a focus for the University Limerick Hospitals Group and it is committed to improving the service for its patients.

Developing services around insulin pump therapy and structured education requires them to fill further specialist posts, including nursing and dietician posts. While there is a specialist dietician working with the paediatric diabetes patients, there is currently no specialist dietician in post for adults with type 1 diabetes. Patients are seen by a ward dietician as inpatients, but currently, there is no specialist dietetic care or outpatient appoints available for adult diabetes patients in UHL.

In December 2020, the hospital group received confirmation of funding to recruit three additional dietetic posts for the treatment of adult diabetes. This funding has been made available through the national clinical programme for diabetes. These posts include two senior dieticians and one staff grade dietician. The recruitment process for the two senior dieticians is at an advanced stage. The recruitment process is also ongoing for the staff grade dietician post. UHL has advised that it will be able to provide a more precise timeline on when it expects the successful candidates to take up post in the the near future. A second consultant endocrinologist took up post on 1 October 2020. Two further consultant endocrinologist posts have now been approved. They are currently being progressed through the approved HR process. UHL will advise when the consultants are in place.

The adult diabetes service is also supported by a dedicated team of clinical nurse specialists and staff nurses. Four diabetic clinical nurse specialists, CNS, posts have also been approved for UHL. Of these, three have been successfully recruited and the successful candidates will commence post in the coming months, while the recruitment campaign is currently ongoing for the final CNS post. There are also two dietetic staff nurse positions within the diabetes unit at UHL, both of which have been filled.

UHL has advised that the provision of the dose adjustment for normal eating course for adults with type 1 diabetes will be dependent on the appointment of specialist dieticians and on the recruitment of additional CNSs. Currently, the adult service in UHL is unable to commence adult patients on insulin pumps due to service demands. However, it does accept patients established on pumps from elsewhere. These patients are managed under the care of a consultant endocrinologist. The largest group of these are patients who have transferred from the paediatric service in the region. All of the hospital group's insulin pump patients are seen in UHL. At present, there are 51 patients within its adult diabetes service who are using insulin pump therapy.

That information from the HSE, which is the kind of information that it has been giving us for the last nine months, is cold comfort to the patients who are waiting. They are living with a life-altering illness and need access to the services and support to which they are entitled, in keeping with other patients attending other hospitals around the country. I will quote one of the many patients who has contacted my office seeking help:

I feel, as a patient, that the HSE is letting us diabetics down as they are not providing us with the services which are very important to us to live as normal a life as possible and to avoid long-term complications. UHL is a regional hospital that covers Limerick, Clare and Tipperary, and over 20,000 diabetics live within these counties. It is a disgrace that we are being left behind, compared to similar sized hospitals that offer services to diabetics. I have to go to a private hospital to access services that UHL is not providing. I should not have to do this.

For those who cannot afford to access private services, what is the solution? As a medical doctor, the Tánaiste will be aware that diabetes, if not managed properly, is a serious illness with life-changing consequences.

It is a very common condition that can be successfully managed. Patients deserve to have access to technological advances to give them every advantage in coping with the illness.

I cannot begin to understand the frustration patients must feel if they are not able to get access to modern treatment such as this, and the anger they must feel when they see people receiving this treatment in other regions and it is not available in their own. I do understand this. What I can say from the Government's point of view is that funding has been allocated to University Hospital Limerick to hire the additional specialist staff that are needed. We are committed to getting the service up and running. I certainly encourage anyone involved in the recruitment process in the HSE and in University Hospital Limerick to expedite this and make sure the staff are hired. I understand, as is the case throughout Ireland and the world, that there is a huge shortage of people who have the specialist skills to fill these posts at a time when demand is rising but that is not an excuse. It may be a reason but it is not an excuse. The funding is there and we are determined to get the service up and running as soon as possible.