Ivana Bacik (Independent)

There have been a number of different pronunciations in the House. Podiatry is the branch of medicine which deals with lower legs and feet. About 50% to 60% of the work of HSE podiatrists is connected with diabetes. We know that adults with diabetes are prone to nerve damage in their feet and legs, and that infections in those with diabetes can easily become leg or foot ulcers. We have done some research on this within the Labour Party, and I am staggered by the cost to the health service of the treatment of such ulcers. This is an issue that is perhaps not uppermost in people's minds when they talk about diabetes treatment, but it is a major issue for people with diabetes. Six thousand cases of foot or leg ulcers were recorded by the HSE between 2005 and 2009. Each of them cost €30,000 to treat, with patients staying in hospital for an average of 35 days, and a staggering 1,500 of these ulcerations led directly to lower limb amputation. Thus, inadequate podiatry services have real consequences for people with diabetes, and that is why this campaign is being run.

As my colleague Senator Prendergast, the Labour Party health spokesperson in the House, pointed out, last month's HSE report on diabetes showed a decrease in the prevalence of foot ulcers for patients with both type 1 and type 2 diabetes which represents considerable progress and can be attributed to the implementation of an evidence-based foot care protocol and a limited increase in the number of patients undergoing regular foot assessment and review by a podiatrist. However, although there have been developments in the treatment and management of diabetes, including this particular consequence of diabetes, Ireland still lacks a comprehensive foot screening programme. The Diabetes Federation of Ireland has called for such a screening programme, which it says will reduce the number of foot ulcers and resulting lower limb amputations caused by poorly managed and in many cases undiagnosed diabetes.

The introduction of such a programme would bring massive benefits to all involved, particularly those unlucky enough to be diagnosed with diabetes or whose conditions go undiagnosed until they manifest in the sort of foot conditions about which we are speaking. An investment in podiatry services would reduce the number of avoidable complications, which in many cases lead to prolonged hospital stays, long periods of immobility or amputation. In many areas, patients are being subjected to undue suffering that could be avoided if we had adequate podiatry services and better provision of such services across the country. The focus of some e-mails I received has been on particular areas such as north Dublin city and county, but we need to ensure there is a consistent level of treatment available across the country.

Adult-onset or maturity-onset diabetes, known as type 2 diabetes, usually develops slowly in adulthood. With an average of seven years between onset and diagnosis, the earlier the condition is detected, the easier it is to reduce the risk of long-term complications. Even with our focus on ulcers and infections of the feet, it is important not to lose sight of other serious consequences of diabetes, such as heart attack, stroke, kidney failure and eye disease - the latter a consequence of diabetes with which I am more familiar. Not only does the lack of an extensive treatment programme cause undue suffering for patients, but it has a serious impact on ongoing costs due to the necessity of intervening later when conditions such as eye disease have become much more serious. We spent €239 million treating preventable diabetic foot complications between 2005 and 2009. The Diabetes Federation of Ireland has estimated that we could reduce the inpatient cost of treating diabetic foot disease by between 50% and 70% after five years by investing more at an earlier stage on an adequate treatment programme on foot complications from diabetes. It would make sense to reduce the amount of money we spend on treatment by preventing the onset of diabetic foot complications and by ensuring we have a decent screening programme and follow up service. A modest investment of just €1.56 million per year could provide a nationwide screening service leading to less suffering for people diagnosed with diabetes and a lesser ongoing cost for the HSE. Not investing in podiatry services represents a mismanagement of available resources when the consequences to the individual patients and their families, and the health service generally are so severe. We have a chance to improve our health service at a relatively low cost which will represent a long-term saving to the Government. It is of utmost importance that the Government acts on the issue rather than just paying it lip service.

In 2012 I understand Ireland's first podiatry students will graduate from NUI Galway and we hope they will not need to follow other graduates who will be forced to emigrate when we could do so much with their expertise at home.