Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the Senator for raising the issue and even if the issue was solved, we would have to consider the broader process. Diabetic foot disease is one of the most common, serious, feared and costly complications of diabetes. Patients with diabetes are between 15 to 40 times more at risk of a lower limb amputation than their non-diabetic counterparts. Some 80% of lower limb amputation in diabetes is preceded by the development of a foot ulcer and it is estimated that the annual incidence of lower limb ulceration in patients with diabetes varies from 2.2% to 7%.

Diabetic foot disease is costly, with patients frequently requiring admission to hospital, investigations, surgery and a prolonged hospital stay. International studies show that targeted foot care and proper screening of at-risk cases can result in a reduction in the incidence of foot ulcers in patients with diabetes. With the targets of reducing foot ulcers, lower limb amputations and hospital costs in patients with diabetes, the national diabetes programme submitted a business case for the 2011 HSE service plan and was successful in recruiting 16 extra podiatrists across the country to manage diabetic foot care. As a consequence, the national diabetes programme developed a national model of diabetic foot care using current podiatrists and newly-appointed diabetes podiatrists. It is hoped that over time, the number of diabetes podiatrists will increase and the model will change and adapt to accommodate the increase in podiatry numbers.

The Government has decided that the numbers employed across the public service must be reduced in order to meet the fiscal and budgetary targets. The end 2012 health service employment ceiling has been set at 101,960. Within the overall ceiling, the HSE can make exceptional appointments but the number of posts must be kept to a minimum given the need for the health sector to make financial savings this year in additional to the employment targets.

Given the HSE's current financial situation, it introduced a recruitment pause in July this year. Apart from critical exceptions, this pause applies to all posts except for service plan development posts in primary care, mental health and child protection. The HSE has confirmed that a 0.5 whole-time equivalent podiatrist was recruited and commenced employment on 5 June 2012 in Cavan General Hospital. Unfortunately, the individual resigned from the post on 31 October. However, the HSE has commenced the process of recruitment in an effort to fill this post as soon as possible. Meanwhile, an interim contingency plan is in place to ensure a podiatrist is providing care to patients who have been prioritised as requiring urgent attention. The cumulative impact of staff reductions from this year and previous years presents a significant challenge for the health system in delivering services. However, the HSE is seeking to mitigate the impact of these reductions by using the provisions of the public service agreement to bring about greater flexibilities in work practices and rosters, redeployment and other changes to achieve more efficient delivery of services; delivering greater productivity through the national clinical programmes to reduce the average length of stay, improve day of admission surgery rates, increase the number of patients treated as day cases, etc.; and limited and targeted recruitment in priority areas.

The Senator has rightly outlined the issue relating to diabetes and it is one of the clinical programmes we intend to deliver through primary care. Advances have been made but, I agree entirely, not enough