Batt O'Keeffe (Cork North West, Fianna Fail)

I thank Deputy Deenihan for raising what is a very important issue on the Adjournment. I am taking it on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The national diabetes programme was established under the governance of the quality and clinical care directorate of the HSE to progress a national diabetes plan which has five key objectives, namely, to establish a national diabetic retinopathy screening service; to establish a national diabetes register; to progress foot care services nationally; to facilitate integration of diabetic services between primary and secondary care; and to develop strategies to improve diabetic control and risk reduction to prevent diabetic complications. A clinician has recently been appointed to take the lead on the diabetes clinical programme. He is currently engaging with all stakeholders, including the Diabetic Federation of Ireland, clinicians and podiatrists to establish a multi-disciplinary foot care package for diabetic patients.

Chiropodists-podiatrists are specialists in all aspects of foot health and also treat people suffering from the complications of diabetes, such as peripheral vascular disease. The aims of the podiatry service are to maintain mobility and independence in older people through assessment, treatment, education and support in a clinical and home environment; to perform total and partial nail surgery under local anaesthetic to children and young adults presenting with repetitive nail trauma; and the education and assessment and care of diabetic patients to prevent complications of the foot.

Patients requiring podiatry assessment and treatment may be referred from GPs, primary care team members, diabetes services and hospital services. The HSE currently provides a podiatry service to medical card holders. The provision of chiropody-podiatry services varies in different regions in the HSE and can be provided by chiropodists-podiatrists employed directly by the HSE and treatments provided by chiropodists-podiatrists contracted under the CMS scheme. These provide services on a sessional basis for clients eligible under the GMS scheme.

Chiropodists-podiatrists who undertake these sessions are taken from the list of approved chiropodists-podiatrists who have been assessed for eligibility to practise in the public health service. In some areas a service level agreement is entered into with chiropodists-podiatrists for the provision of services to eligible persons. Monitoring arrangements are in place for the execution of these agreements while grant aid is provided to voluntary agencies for the provision of podiatry services under section 39 grant aid.

A number of initiatives have been undertaken recently such as the development of a standardised podiatry assessment tool for diabetic patients. This will enable referring GPs and practice nurses to give the podiatry department an accurate assessment of the status of diabetic patients' foot condition which, in turn, will ensure that the podiatry department can identify and prioritise high risk diabetics and provide timely intervention as required.

In advance of the recent establishment of the national programme, a diabetes services implementation group for HSE south was set up and has been in operation in counties Cork and Kerry for the past two years. Its report on foot care services in both counties is due for presentation in the coming weeks.

The diabetes service at Kerry General Hospital is led by a consultant physician with a special interest in endocrinology who utilises and develops facilities in the area of diabetes. There are three dedicated consultant diabetes clinics held each month at the hospital. In addition to these clinics, the specialist diabetic nurses provide outpatient clinics at Kerry General Hospital and outreach clinics in the community.

Podiatry input is recognised as an essential element in the multi-disciplinary approach required to maintain the health of the diabetic population. Primary care teams, acute hospital services and the regional diabetes services implementation groups are collaboratively working to improve provision and access to podiatry services for people with diabetes. The Minister is assured that Kerry General Hospital and HSE south are committed to providing the best possible quality of care to all diabetic patients within the reasonable resources available.

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