Paul Kehoe (Wexford, Fine Gael) | Oireachtas source

I thank the Senator for raising this important issue. The Department of Health's chronic disease framework policy, launched in 2008, was designed to reduce the challenges associated with chronic disease. It emphasised the need to develop shared and integrated care, thus avoiding unnecessary hospital admissions and delivering improved quality of life for those affected. The HSE clinical programme for diabetes follows this chronic disease framework. The HSE national clinical programme for diabetes which includes the care of children and adolescents with diabetes was established within the clinical strategy and programmes directorate. The purpose of the programme is to define the way diabetic clinical services should be delivered, resourced and measured to save the lives, eyes and limbs of patients with diabetes.

Diabetic foot disease is one of the most common, serious, feared and costly complications of diabetes. Patients with diabetes are between 15 and 40 times more at risk of a lower limb amputation than their non-diabetic counterparts. A total of 80% of lower limb amputations in patients with diabetes is preceded by the development of a foot ulcer. It is estimated that the annual incidence of lower limb ulceration in patients with diabetes varies from 2.2% to 7%. Treating 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 the incidence of foot ulcers, lower limb amputations and hospital costs, the national diabetes programme submitted a business case for the 2011 HSE service plan and was successful in recruiting 16 extra podiatrists throughout 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 over time that the number of diabetes podiatrists will increase and that the model will change and adapt to accommodate the increase in podiatrist numbers.

The Government has decided the numbers employed throughout the public service must be reduced to meet fiscal and budgetary targets. The health service employment ceiling for the end of 2012 has been set at 101,960. Within the overall ceiling, the HSE can make exceptional appointments. However, the number of posts must be kept to a minimum, given the need for the health sector to make financial savings this year, in addition 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. Wexford General Hospital has received approval for one senior podiatrist post in line with the national diabetes programme. The post was originally advertised in March. However, it was not filled at that time. It has now been sanctioned for readvertising. In the interim, a sessional podiatrist has been recruited to provide services.

The cumulative impact of staff reductions in this 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 flexibility to achieve more efficient delivery of services; to deliver greater productivity through the national clinical programmes to reduce the average length of stay; to improve day of admission surgery rates; to increase the number of patients treated as day cases; and to have some limited and targeted recruitment in priority areas as mentioned.