Kathryn Reilly (Sinn Fein)
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I welcome the Minister of State to the House. This issue concerns podiatry services and I am sure the Minister of State is aware there was much concern about the availability of podiatry services and posts in various hospitals across the State, especially promised positions and posts that have not been filled. I raised in particular the case of Cavan general hospital and the HSE issued a response at 5 p.m. yesterday in this regard. It confirmed that a podiatrist had been recruited and commenced employment in the Cavan hospital but the post holder subsequently resigned. The HSE is commencing a process of recruitment to fill the post.

The Cavan-Monaghan hospital group has advised that there is an interim contingency plan to ensure that a podiatrist is providing care to patients who have been prioritised and require urgent attention. As the focus of this matter has shifted, I will highlight the background to the request for the matter, particularly the contingency plan that will be in place until the post is filled in Cavan hospital. There seems to be much uncertainty, particularly with regard to patients with diabetes, who have a concern about the filling of those positions not only in Cavan but across the State.

The HSE promised it would provide 16 whole-time equivalent podiatrists in 2010 across Ireland to screen for foot disease and deal with at-risk feet. The national diabetes programme set a target of 30 April 2012 for the recruitment and appointment of podiatrists. Figures from November indicate that six of the 16 posts are officially deemed to be filled by the HSE, and there is concern that the recruitment embargo was affecting the filling of these positions. Will the Minister of State clarify why the posts have not been filled? There is concern, particularly among patients with diabetes who are trying to avail of this care. There is a high incidence of amputations in the past couple of years, with 2,539 people with diabetes having lower limb amputations between 2005 and 2011. Therefore, the availability of podiatrists is important.

We received the two-line response from the HSE yesterday evening. Will the Minister of State confirm that the position promised is subject to an ongoing recruitment process? A podiatrist had been appointed but resigned. What is the contingency plan to service the Cavan hospital, which must service both Cavan and Monaghan?

Kathleen Lynch (Cork North Central, Labour)
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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

Kathryn Reilly (Sinn Fein)
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If the Minister of State could pass on information on the stage the recruitment process is at, I would appreciate it. Given the person holding the post would have given notice, I do not want this to take too long.

Kathleen Lynch (Cork North Central, Labour)
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I will get further information for the Senator but my experience is that it takes a considerable number of weeks between advertising, recruitment and getting someone in post.