Jimmy Deenihan (Kerry North, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this matter on the Adjournment tonight.

The answer to a recent parliamentary question I tabled indicated that during 2008 some 667 people underwent an amputation in hospitals, of whom 338 suffered from diabetes; some 29 of these were from the Kerry and Limerick area. People with diabetes requiring amputations used 12,937 hospital bed days in 2008, of which 10,132 were in publicly funded hospitals. In 2007, the figure was 11,637, of which 11,209 were in publicly funded hospitals. The inpatient costs of the publicly funded health service for these patients was in excess of €7.4 million in 2008 and €7.2 million in 2007. This cost relates to the inpatient stay only and specifically excludes outpatient, emergency department and day-care costs. Neither does it include lifelong social welfare payments, housing renovation costs and so on.

Prior to having an amputation, these people usually spend many months in hospital having treatment for their ulceration. In addition to those requiring amputations, people with diabetes suffering from foot ulcers are also occupying hospitals beds. These ulcers develop as a result of friction and uneven pressure on the foot which leads to minor problems compounded by poor blood supply and nerve dysfunction. Access to a podiatrist would ensure that minor problems were identified early and corrected, thereby preventing major problems later.

There are no diabetes podiatry services in Kerry or Limerick. A podiatry service should be freely available to all people with diabetes. In County Kerry in 2008, 108 required inpatient treatment for foot ulceration. Some 53 of these had diabetes.

Currently, there are no public podiatry services in County Kerry. There are only two full-time podiatrists available through the public health system in Ireland. However, there are 20 students in the Galway podiatry school due to qualify in 2012. They will be first Irish-trained podiatrists but they will not be employed due to the recruitment embargo. There must be a change in this policy.

In an ideal world, County Kerry should have seven new podiatry posts but, at a minimum, two podiatrists - one for north Kerry and one for south Kerry - should be appointed. Research has shown that this would reduce the level of amputations by as much as 70% annually, resulting in huge savings for the Government and the HSE.

County Kerry has been very much neglected as regards services. For example, even in cardiology, a public cardiologist is shared with the Bons Secours Hospital and that is only for four units out of ten units of his time. We have few services in regard to rheumatology, etc., but we have no public podiatry service and that is the reason so many people in County Kerry have amputations and so many of them have major foot problems.

I appeal to the Minister, Deputy Batt O'Keeffe, to convey the message that when podiatrists are being appointed that County Kerry is not left out again and that it gets what is essential for the health of the people of county.

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