David Norris (Independent)

I welcome the opportunity to take part in this debate. I regard myself as very lucky to do so because it had not been on the programme that we would be meeting at this time. When it was rearranged I had several other engagements, all of which I have just managed to fulfil. I have just come hotfoot from Trinity where I was introducing a very important Italian film regarding that country's attempt to do what this House did recently, which is to introduce a civil partnership Bill. While I was unable to see the film I came straight down here because like many of my colleagues, I was contacted by a large number of people with concerns in this area. I delayed replying to all of them, because it was a real flotilla of e-mails and messages until we had this debate so I could refer them to it as I believe they will be heartened by what has happened tonight.

I commend Fine Gael and Labour on not amending the Government motion, which represents a positive approach without the usual mean-minded Wednesday evening tit-for-tat point scoring. I believe that was partly because the Government worded the motion sensitively and in a non-confrontational manner on which I compliment it also.

Instead of contacting all the people who sent me e-mails I went to the source of what I thought would have been the best information. As it may very well be that my colleagues also had access to this, if I am repeating things already said, I apologise. I wrote to Mr. Kieran O'Leary, the chief executive officer of the Diabetes Federation of Ireland. He wrote back explaining that it wished to engage in a programme reducing the number of costly foot ulcers and lower-limb amputations. I am sure very few of us would have realised that diabetes can lead to a situation not entirely dissimilar to the appalling scourge of leprosy. As a result of the impact of diabetes particularly on the lower limbs the nerves become desensitised and as a result patients with diabetes when they reach this point may very well be unaware of what are initially minor abrasions, scrapes cuts and so on, which can become infected and a major source of ulcers leading to gangrene followed by the amputation of the lower limbs. That is an extraordinary progression from a minor graze to the amputation of a leg, which is almost invariably followed by the amputation of the second leg, which in a large number of cases is fatal. So we are dealing with a fatality that comes from something fairly minor.

I encourage anybody who may be involved in this situation to go to the website because the information there is very clear, accessible, simple and practical. It deals with, for example, examination of the foot, particularly by elderly people. It also refers to the use of professionals because sometimes if people, particularly elderly people whose eyesight may not be good, attempt to rectify a problem such as overgrown toenails, they can without noticing it inflict a wound that may become a serious problem for them. The website recommends first of all inspection, not just to use one's own skills but to seek where possible professional assistance in chiropody etc. and then to maintain a strict regime of hygiene and the use of ointments and so on.

While I do not have diabetes, as I grow older I find I have some of the exact symptoms being described on the sole and ball of the foot. Particularly if one wears sandals in the summer the skin can become calloused and hardened. I have had extremely painful splits in the hard tissue that builds up. It is comparatively easy to treat; in the past year I have got a couple of little instruments. In the bath the skin gets softened and one can scrape it off, which avoids the situation which is merely uncomfortable for me, but could be serious, dangerous and possibly even fatal for people with diabetes. That is the humanitarian thing - the avoidance of suffering.

I am sure the Government will be open to the very clear financial argument, some of which has been sketched out as I just heard in the end of Senator Bacik's speech. It is very telling that the costs can be reduced by this simple foot-screening programme. Approximately 6,000 foot or leg ulcers were recorded by the HSE between 2005 and 2009 each of which cost between €9,000 and €30,000 to treat. Each patient stayed in hospital for an average of 31 days with 1,500 patients having ulcers, which are prone to gangrene, leading directly to a lower limb amputation in the same period. The statistics then become even more worrying. Some 70% of people who lose a limb in this manner will lose the other leg via a contralateral amputation within 18 months. Some 40% of people who lose a leg through amputation die within five years - a worse survival rate than for breast cancer.

Some €239 million was spent treating the complication of diabetic foot disease between 2005 and 2009. A national screening programme costing only €1.65 million per annum could save from 40% to 70% of the treatment cost within three years. We are in a state of budgetary restrictions with everything being cut back. Here is a programme which will save people from misery, save lives, maintain the good health of citizens, particularly the elderly, and will save perhaps up to €100 million for the Exchequer.

This is a very welcome motion that is practical, simple and capable of being acted upon. Obviously the motion has the support of the Department of Health and Children or else it would not have made it onto the Seanad Order Paper from the Government side. I ask the Minister to give some assurance that such a foot-screening programme will be introduced as soon as possible and I ask her to give a timescale for doing so. If there is any disagreement with the Department of Finance, the record of the debate in this House should indicate a significant saving for the Exchequer. We can do the right thing and save money as well as saving people's lives and improving their health. It represents that unusual phenomenon in these difficult days of a win-win situation.