Thursday, 7 October 2010
I thank the Cathaoirleach for allowing me to raise on the Adjournment the issue of podiatry services for people with diabetes. A very strong campaign has been conducted across the country, particularly in County Cork, on the absence of leadership by the Government and the HSE in the management and treatment of diabetes. Approximately €23.3 million was spent between 2005 and 2009 treating what the Fine Gael spokesman on health, Deputy Reilly, would consider to be preventable diabetic foot disease complications. This expenditure illustrates short-term thinking in the health service. Of the 1,691 patients from Cork city and county admitted for treatment for foot ulcers during the five-year period, one third had diabetes. A further 202 people with diabetes from County Cork had to have a lower limb amputation in the same period, a very high figure when one considers that 5% of the population suffer from diabetes. When one also considers that the paediatric diabetes service is poor and that the Minister and HSE have on a number of occasions been asked to be more proactive in this regard - they have not been - one will see that we are now forcing people with diabetes into under-resourced treatment services. We are prolonging hospital stays and spending money badly.
In the HSE South area €75 million was spent in treating approximately 2,500 inpatients with diabetes for diabetic foot disease between 2005 and 2009. That figure could be lowered by employing one hospital or community podiatrist to work locally to prevent contraction of the disease. In so doing one could run a foot screening programme that would, according to the Diabetes Federation of Ireland, cost a maximum of €80,000. For an investment of €1.56 million we could employ 20 podiatrists and provide a nationwide service. Ireland currently has the lowest number in Europe of employees providing podiatry for diabetes, has only two hospital podiatry posts and, I suggest, a broken and unco-ordinated community service. The report of the Health Service Executive advisory group published in 2008 recommended we employ 100 podiatrists. I accept we will not be able to do this in the current economic climate but an investment of €1.56 million would allow us to employ 20 podiatrists. I am quoting in this regard statistics provided by the HSE. The effective control of diabetes would lead to a massive reduction in the development and progression of complications, a significant reduction in the number of amputations and a reduction in the number of people seeking hospital beds, resulting in savings to the State.
I look forward to hearing the Minister of State's reply. While I accept this is not his area of responsibility, I hope his reply will be positive.
Seán Haughey (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Dublin North Central, Fianna Fail)
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I thank Senator Buttimer for raising this matter. I am responding on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.
The national diabetes programme was established under the governance of the quality and clinical care directorate of the Health Service Executive 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 and he is currently engaging with all stakeholders, including the Diabetic Federation of Ireland, clinicians and podiatrists to establish a multidisciplinary foot care package for diabetic patients.
General practitioners are competent in managing diabetes and all of its complications, including those affecting the foot. Chiropodists and podiatrists are specialists in all aspects of foot health and also treat people suffering from the complications of diabetes, including 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, assessment and care of diabetic patients to prevent complications of the foot. Patients requiring podiatry assessment and treatment may be referred from general practitioners, 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 of the HSE. Services may be provided by chiropodists and podiatrists employed directly by the HSE. Chiropodists and podiatrists are also contracted under the GMS scheme. These provide services on a sessional basis for clients eligible under the GMS scheme. Chiropodists-podiatrists who undertake these sessions are taken from a list of approved chiropodists and podiatrists who have been assessed for eligibility to practise in the public health service. In some areas of the country, 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.
A number of initiatives have been recently undertaken, including the development of a standardised podiatry assessment tool for diabetic patients. This will enable referring general practitioners and practice nurses to give the podiatry department an accurate assessment of the status of a diabetic patient's foot condition which, in turn, will ensure 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 Cork and Kerry for the past two years. Its report on foot care services in Cork and Kerry is due for presentation in the coming weeks. The diabetes podiatry service at Cork University Hospital, CUH, is a specialist tertiary referral service provided to people suffering from diabetes-related foot complications. The diabetic foot clinic is an integral part of the endocrinology department at CUH, supporting and facilitating diabetes day care and inpatient care. Comprehensive assessment and specialist treatment of acute diabetic foot problems are provided. Access to the service is available to patients under the care of the endocrinology department presenting with acute diabetic foot problems such as diabetic foot ulceration and gangrene. The impact of this service has been to reduce the number of admissions and amputations for patients with diabetes. Localised podiatry services are also provided in the community through local health office primary care structures in the city and county. This is a generic service for all care groups which accept referrals from GPs, public health nurses and other relevant health professionals.
Podiatry input is recognised as an essential element in the multidisciplinary approach required to maintain the health of the diabetic population. Primary care teams, acute hospital services and the regional diabetes services implementation groups are working collaboratively to improve provision and access to podiatry services for people with diabetes. The HSE South is committed to providing the best possible quality of care to all diabetic patients within the resources available.
While I thank the Minister of State for his reply, it is wholly inadequate in terms of specifics and on improvements in the service. I ask that he inform the Minister for Health and Children, Deputy Harney, that the response does not deliver a commitment to upgrade or provide a better service to the people.