Jim Walsh (Fianna Fail)
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I welcome my constituency colleague. In the current climate it is easy to fall into the trap of being penny wise and pound foolish. Yesterday at a meeting of the Oireachtas Joint Committee on Foreign Affairs and Trade we had an example where the Irish Exporters Association and IBEC referred to the fact that some of our offices abroad had reduced the number of individuals promoting trade, which is necessary for growth in the economy. This is a prime example of being penny wise and pound foolish.

I call on the Minister of State to make a statement on the increase in the incidence of diabetes related foot ulcers and amputations; to clarify the status of the podiatry post at Wexford General Hospital sanctioned in April; and to state when the position will be filled. Podiatrists cost approximately ¤100,000, which includes salary costs and expenses. The cost of employing a podiatrist to work with diabetes patients would be offset by the saving in preventing three hospital admissions with foot ulcers. Treating a foot ulcer can cost ¤30,000 and cause someone to be in hospital for months. If there is a need for amputation as a consequence, it leads to the making of disability payments. A huge contingent liability is attached to not dealing with this issue.

Podiatrists are able to refer persons at risk and train nurses in GP practices to screen for foot related problems. A failure to fill the position in question is resulting in an increased incidence of foot ulcers and amputations in the area. In tackling diabetes in the community it is critical to keep persons with health complications out of hospital, healthy and mobile. I am speaking about the hospital in Wexford, but I could equally make the point about hospitals in Waterford, Kerry, Kilkenny, Mullingar, Drogheda and Cavan, as well as Beaumont Hospital and the Mater Hospital. There has been much evidence of an increase in the rate of diabetes, as the Minister of State would acknowledge. Therefore, the participation of this profession is essential if we are to curtail the consequences of diabetes.

Will the Minister of State guarantee that the post will be filled immediately? He knows the HSE specifically exempted Wexford in the latest round of the recruitment embargo in July, but the post has still not been filled. Funding for it was allocated in the HSE South 2012 podiatry business case budget and approved by the regional director of the HSE. Why, despite the allocation of funding and the granting of approval, has the post not been filled? I appeal to the Minister of State and the Minister for Health to take immediate action to fill the post in Wexford and, by extension if one accepts the argument made, elsewhere also. Failure to do so will lead to a huge additional cost to the State. This post will pay for itself in terms of preventive measures and is absolutely essential.

Paul Kehoe (Wexford, Fine Gael)
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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.

Jim Walsh (Fianna Fail)
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I am as wise now as when I started. I accept that the Minister of State who is not attached to the Department of Health has read a prepared script given to him by the Department, but the questions I asked were very specific. Will the post be filled immediately and, if not, when will it be filled? I did not receive any indication of this but heard why it had not been filled because of the recruitment embargo. We are trying to save money, but only one third of the salary is being saved because staff leave on a pension of 50% and we are losing tax on the other 50%. Because most of those who work in public services are on very high salaries, they pay tax at a rate 41%. Therefore, a saving of only 30% is achieved in letting staff go. The problem is that salaries and pensions are far too high, an issue which is not being addressed. Until we address it, problems such as this will continue to arise. We are consigning people with diabetes to developing foot ulcers, undergoing amputations and receiving disability payments. It does not make financial sense and makes no sense in promoting the well-being and health of those unfortunate enough to have diabetes. I, therefore, ask the Minister of State to take this issue to the Cabinet table to get the Cabinet to adopt a sensible approach on the policies it is implementing in this sector.

Paul Kehoe (Wexford, Fine Gael)
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I reiterate that Wexford General Hospital was approved for one senior podiatrist post in line with the national diabetes programme. The post was originally advertised in March 2012, but it was not filled at that time. The post has now been sanctioned for readvertisement. In the interim, a sessional podiatrist has been recruited to provide these services. I do not have the exact timeframe for when a person will be appointed. I am sure people will show interest in the position when it is advertised and it will be filled on that basis.

Jim Walsh (Fianna Fail)
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Can the Minister of State confirm that to me in writing?

Paul Kehoe (Wexford, Fine Gael)
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It is interesting that the Senator was not as vocal about salaries and pensions when he was on the other side of the House.

Jim Walsh (Fianna Fail)
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On a point of order, I was the strongest voice in the House on the issue of public service salaries and pensions during the period when we were in government. The Cathaoirleach knows that because he was here.

Paddy Burke (Fine Gael)
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I ask the Senator to resume his seat.

Paul Kehoe (Wexford, Fine Gael)
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If had been so strongly vocal at that time, maybe he should have resigned from Fianna Fáil on a point of principle.

Jim Walsh (Fianna Fail)
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The Minister of State is in government now and he has not addressed it.

Paul Kehoe (Wexford, Fine Gael)
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The Senator raised the issue. Compared with what his crowd did in the past ten years, we have introduced-----

Jim Walsh (Fianna Fail)
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The Government has not addressed it. The Minister of State should examine the matter again.

Paul Kehoe (Wexford, Fine Gael)
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If the Senator had been as strong then as he is now, perhaps we would be in a different position.

Jim Walsh (Fianna Fail)
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Our colleague, the Minister, Deputy Howlin, was not able to answer a single question when he was here last week.

Paul Kehoe (Wexford, Fine Gael)
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When the Senator's party was in government, it brought this country to its knees and landed us with the current economic climate.

Jim Walsh (Fianna Fail)
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If we had taken the advice offered by the Minister of State's party when it was in opposition, the fiscal difficulties would be even greater.

Paul Kehoe (Wexford, Fine Gael)
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We are trying to fix it. The Minister for Finance was in this House yesterday. Perhaps Senator Walsh should table more of these Adjournment debates. I feel sorry for him because he seems to be suffering as a result of what has happened in recent years.

Jim Walsh (Fianna Fail)
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The Minister of State does not need to feel sorry for me. I feel sorry for the people because the Government is not delivering on the promises it made before last year's general election.

Paul Kehoe (Wexford, Fine Gael)
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I have set out the position as detailed by the Minister for Health. As a Wexford man, I will follow up on the matter with the Minister to make sure this position is filled as soon as possible.

Jim Walsh (Fianna Fail)
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Can the Minister of State ask him why it was not filled previously?