Diabetes Treatment and Management: Motion

I move:

That Seanad Éireann:

acknowledges the public health concerns surrounding diabetes and its increasing prevalence;

recognises the work already done in the area of strategic policy development to tackle diabetes;

endorses the efforts being made to highlight the benefits of healthier lifestyle behaviours as a means of preventing this disease; and

encourages the Health Service Executive to continue to develop and roll out models for the ongoing treatment and management of the disease and its complications.

I welcome the Minister of State at the Department of Health and Children, Deputy Áine Brady, and thank her for her presence. A few short years ago during the period of the wonderful Celtic tiger, which we all know is dead, the mantra throughout the country was "location, location, location". It was all about investing in a property and which area would garner the best return on an investment. Instead of "location, location, location", the new mantra is "lifestyle, lifestyle, lifestyle". Current lifestyle patterns in this country form an issue of considerable concern. As the Minister of State well knows from travelling around the country and from her job, lifestyle patterns are storing up problems for us as a nation.

I was not surprised to see the seven factors that are the commonest causes of type 2 diabetes. The first is high blood pressure, the second, tobacco, the third, alcohol, the fourth, high blood cholesterol, the fifth, being overweight, the sixth, a low fruit and vegetable intake, and the seventh, physical inactivity. Some are guilty of all of these and others of a few. Up to 90% of the 7,000 cases of type 2 diabetes could have been prevented by taking all or even some of the seven factors into account. It is important to note that type 2 diabetes can be prevented.

I would never have considered diabetes to be a killer disease but it is. I compliment the Diabetes Federation of Ireland which from time to time sends us e-mails. One of its most recent e-mails I received related to the cost of diabetic foot disease in my constituency and the need for a national foot screening programme to reduce the number of costly foot ulcers and resulting lower limb amputations caused by poorly managed, undiagnosed diabetes.

Diabetes is the commonest undiagnosed problem, especially in men. A cohort of patients are prone to various diseases but late onset type 2 diabetes is very common in men in their 50s, 60s and 70s, depending on their lifestyle. I was surprised to read that approximately 7,000 foot and leg ulcers were recorded by the Health Service Executive between 2005 and 2009. Each ulcer cost between €9,000 and €30,000 to treat. What was even more staggering was that the average hospital stay of each of those patients was 21 days. A total of 1,500 of those ulcers, which are also prone to gangrene, led to lower limb amputation in the same period. Approximately 70% of those who have an amputation will probably have the corresponding limb on the other side of their body amputated within 18 months. If one was in the most horrific car crash one could imagine what it would be like to wake up and find one was in a wheelchair and no longer able to walk, or that one's leg was so badly crushed that one had to have it amputated. At least one would be able to say it might have been God's will and that one got away with losing a leg in a severe car crash instead of a life.

Diabetes is brought on by lifestyle. Therefore, changing lifestyle would save many people from an early death. The House debated the incidence of diabetes in April or May 2009, at which time I mentioned the case of a close friend of the Minister of State and a woman whose company everyone had enjoyed thoroughly, the late Senator Kate Walsh. Everyone knew Kate was a diabetic since she regularly raised the issue on the Order of Business and contributed to debates such as this. She got down on her knees and pleaded with people to change their lifestyle. She was loved in the House and always stated that, if she had had a healthier lifestyle and not been overweight, she could have avoided diabetes. I thought of her today while scribbling a few words. I am sure that, wherever she is in floating around the lovely clouds up above, she will smile and tell us to keep going. She would be particularly proud of the Minister of State present. For her sake and that of all sufferers, we must do whatever we can to push the HSE in the right direction to initiate a screening programme. Consider the lives that would be saved as a result. During our last debate on the subject I understand the Minister of State, Deputy Áine Brady, told the House that a screening programme had been rolled out in the west. How is it progressing and how has it minimised the terrible effects of diabetes with which sufferers must live?

Between 2005 and 2009 a total of €239 million was spent on treating complications associated with diabetic foot disease alone. The Minister of State and I know that 40% to 70% of this amount could be saved in three years. Rolling out the service nationally would cost €1.5 million. We have all been asked to speak to the Minister of State about the roll-out. This question is relevant, given that we are in the run-up to the budget and that money is tight. In that regard, we all had a rude awakening yesterday. Sitting across the floor from me is Senator Twomey who is involved with his party in the talks on the economy and the forthcoming budget. I saw him last night. I am sure he would agree that anything that could be done to save money and, more importantly, lives should be done. Since the figure for cuts in the next four years is €15 billion, we know that €1 billion or a little more will be cut from the health budget, but could the Minister of State and her colleagues, the Minister of State, Deputy Moloney, and the Minister, Deputy Harney, see their way to putting a screening programme in place for people at risk contracting this terrible disease?

From previous debates on health and screening for diseases, I know that men are probably the worst in looking after themselves. Women are more inclined to attend a general practitioner or a GP's nurse when they have concerns, whereas men are inclined to put health matters on the long finger. The television advertisements on the effects of a stroke — we are told to dial 999 or whatever the number is when we see the signs — are scary. Were one to refer to the seven lifestyle factors I mentioned as potential killers, men would try to reduce their level of exposure to them.

The Dublin city marathon was held on Monday. Some of us were in our cars looking at all of the bodies running on the roads. Quite a few Senators participated in the event. However, people run throughout the year. Apart from Members on my side of the House, Senator McFadden also ran in the marathon. Well done to her.

She will never enter the Chamber complaining about having diabetes.

She is one of those people who tells themselves they will be fitter and healthier. Fair dues to her. I am throwing a bouquet at her.

I thank the Senator.

I wish I could have ran a marathon. I ran a mini-marathon this year and that is good when one is aged 50 years or over.

Will the Minister of State consider the matter from the following perspective? Hospital beds are being taken up for an average of 21 days; earnings are being lost and sufferers' jobs are being affected. When people are out of work, it has a significant impact on the social welfare budget. This is all about saving lives and is a win-win. The amount of €239 million spent in treating complications could be reduced to as little as €1.56 million if we were to roll out a national screening programme.

I second the motion before the House. The issue of diabetes is of increasing significance, particularly in the western and developed worlds. According to the statistics, 5% of Ireland's population have diabetes. Where it remains undiagnosed or poorly controlled, it can lead to severe complications, including having adverse effects on the eyes and kidneys, nerve damage and vascular complications. The consequences of controlling diabetes poorly vary. It results in an increased susceptibility to hospital admissions and poor health. In terms of vascular complications, almost 2,500 people were admitted to hospital for the treatment of foot ulcers in my area of south Dublin between 2005 and 2009. Of these, one third had diabetes, while 186 had limbs amputated, a severe consequence. Not only must the people affected live with and try to manage a condition that, in many instances, is preventable, they must do so with a physical disability.

In terms of the economic consequences, the condition can have implications for employment and people's day-to-day quality of life, but it can also affect others. In these days of tight health budgets, an estimated 10% is spent on treating diabetes-related conditions. At the current rate of increase in diagnosis and acquisition of this condition, it is estimated that figure could climb as high as 25% in coming years. That is a very significant proportion of health spending, especially when we consider that in a significant number of cases we could have prevented the onset of the condition in the first instance.

I shall give examples of health care spending. Nationally, and in only one area, namely, foot care or podiatry, we spent in excess of €250 million between 2005 and 2009 on conditions related to diabetes. In Dublin South the figure spent was almost €26 million for those four years. These are significant sums of money and, therefore, I very much welcome the establishment this year of the national diabetes programme under the governance of the quality and clinical care directorate of the HSE. I support its five key objectives which include screening, retinopathy screening and the establishment of a national diabetes register to progress foot care services and facilitate the integration of diabetes services between primary and secondary care. Most important is the development of strategies to improve diabetic control and risk reduction to prevent the onset of diabetes or diabetic complications.

There are two aspects I wish to mention to the Minister of State which are in the areas of prevention and podiatry. Senator Feeney spoke about the importance lifestyle plays and listed the seven factors that cause diabetes. I will not repeat them but reiterate the emphasis she placed on lifestyle factors. Significantly, if one considers such factors as nutrition, exercise and control of tobacco and alcohol consumption, investing in a programme to encourage people to take responsibility for their lifestyle and commence healthier lifestyles has very positive implications not only in the area of diabetes but across all areas of our physical and mental health. I was very struck when I read some of the material that, with the exception of one that was omitted, REM-sleep, the lifestyle factors which have been identified are all those we would use to promote positive mental health. For example, we know obesity, which is strongly linked to the onset of diabetes, has implications for other areas of health. Although I know we are in a time of very tight budgets and it is a struggle to distinguish what we can afford to invest in to get a relatively quick return and what must put on hold for a while, investing the money in promoting healthy lifestyles is good. This applies not only to diabetes but also to the physical and mental well-being of people.

I welcome, as will many others, that the national diabetes programme will place a particular emphasis on the delivery of services in the area of podiatry. If it is the case, as is demonstrated by international research, that we can reduce diabetic foot disease by more than 50% through foot screening and an annual check-up for each person with diabetes, the investment of approximately €1.56 million per annum would provide a nationwide service and significantly reduce costs. Given that the consequences of diabetes can occur very quickly, this investment is one for which we might see a very quick economic return, never mind the positive impact for individuals.

I acknowledge and welcome the fact that a degree course has been available since 2008 and that the first graduates will come from that programme in 2011. The diabetes programme we now have is a good opportunity to make the most of these graduates and ensure we do not lose their newly acquired expertise and training to services abroad but keep them in Ireland and see a practical and concrete return on the investment we have made in their education.

Given the seriousness of diabetes and the awful impact it has on patients in the health care system I am disappointed by the Fianna Fáil motion tabled for the House. Apart from acknowledging there has been an increase in diabetes and we should all live healthier lifestyles, there is no effort to say what strategic policy developments there have been in recent years or what the HSE is developing and rolling out in the treatment and management of the disease.

Diabetes is a shocking disease within the health care system and has a shocking impact on patients and families. As we know, prevention is better than cure but the cure needs a clear management plan and needs to be updated and changed constantly because the care of diabetes also changes constantly. If one talks about changing lifestyles, one must talk about changing the mindset of the people. I have seen patients with below the knee amputations who continue to sit outside hospitals smoking their brains out and patients with poorly controlled diabetes who come to my surgery and have no regard whatsoever for the seriousness of their disease or for their alcohol or smoking habits. There is no point in lecturing such people. It is all about lifestyle changes and changing mindsets about a disease that is increasing all the time.

Senator Feeney is right to say it is almost out of date to talk about diabetes on its own. We now speak about metabolic syndrome which takes into account obesity, blood pressure, high cholesterol and lack of exercise as well as diabetes issues. One can no longer treat diabetes as a separate disease because there are other factors such as the risks posed by high cholesterol and high blood pressure and what obesity and lack of exercise do to the human body. These factors occur with diabetes in very many cases.

When I was Fine Gael spokesperson on health and children I published a detailed screening programme that included not only diabetes but also a number of diseases prevalent in society, again related to cholesterol and blood pressure factors. That was in 2004 but nothing has happened since. Not only did the Government not manage to steal that policy, it made no effort to take on board a very simple screening policy that could have been implemented across the primary care system and that would have had a considerable impact in diagnosing diabetes in people who do not know they have it and instilling the mindset that we must have a different way of looking at these diseases.

When we worked on that policy of screening and dealing with diseases such as diabetes, it was not only what I thought that was important. There were meetings with our education spokesperson, Deputy Olwen Enright, and our sports spokesperson, Deputy Jimmy Deenihan. We recognised it would be very difficult to change the mindset of people in their 40s or even their 30s in regard to their alcohol, smoking and exercise habits. The best place to start changing public policy is in the schools and therefore the treatment of these types of diseases in our society is as much a concern for the Ministers for Education and Skills and Tourism, Culture and Sport as it is for the Minister for Health and Children. We need to get young children active and eating properly and we must open up their minds as to what causes diabetes and many other related diseases.

Clearly, the Government has done very little about prevention and most of what happens within society is simply being done on anad hoc opportunistic basis by general practitioners. There is no clear programme as regards prevention and screening for diabetes within the health care system.

As regards its management, diabetes is considered to be a chronic disease that needs proper management in a structured programme. Dr. Velma Harkins, who is based in the midlands, wrote an excellent programme as regards managing patients with diabetes within the primary care setting. I am not talking about the hospital setting where patients attend clinics once a year, but rather the management of patients in general practice within the primary care setting, with public health doctors and nurses, the practice nurses and their own GPs. That programme has gone nowhere, however. It was an excellent policy that was written up, but it is only implemented where GPs themselves are interested in diabetes. There is no focus from the HSE or drive for the programme to be given by the Department of Health and Children. All we get are more reports and fine words, but no action.

That is why diabetes continues to increase in this society as we continue not to face up to our responsibilities as regards dietary habits, weight, smoking, drinking etc. We are not getting leadership from those we might expect it from. There is a need to be honest with ourselves as regards what is being done and what should be done. However, that type of focus is not happening. I appeal to the Minister of State to go back to basics. Let us look at lifestyle, but also the mindset that changes it. Let us look at prevention, but be honest about what we are going to do in this regard. Prevention is not just about a few advertisements on television. It is also about a screening programme. Just look at BreastCheck and the cervical cancer check programme, and how they have changed the mindset among patients that these diseases exist and something needs to be done about them.

It is the same for diabetes. If there is a screening programme for high cholesterol, high blood pressure or the risk of diabetes within the population, it raises public awareness and that is how we will get action. That is what prevention being better than cure is all about. However, if we have to look after patients who are unfortunate enough to contract diabetes, let us have a proper management plan. The best place to look after those patients is in primary care. The policy is already written. The Minister of State can refer to the Irish College of General Practitioners and speak to Dr. Velma Harkins and others who will show her an excellent policy that may be easily applied right across the country to look after patients in a primary care setting. That helps to reduce the cost of diabetes to the health care system by moving it out of the hospital setting where the more serious diabetes cases can be looked after including patients suffering from complications of the cardiovascular system, renal system and virtually every system of the body.

There is a need for us to adopt that type of proactive approach in dealing with diabetes. There is an immediate cost benefit for the Government if it can get this programme right. It may have to spend €40 million or €50 million on a proper screening programme to look at all illnesses, but that would deliver a very quick return to the State. We need to get back to addressing how medicine should work, in which case we shall do much better for patients in the long-term.

I welcome the Minister of State. She is a regular visitor to this House and is always very welcome.

Listening to Senator Twomey, I find it difficult to disagree with much of what he said. There is absolutely no question that prevention is better than cure. Indeed, the national diabetes programme 2010 has five major points to it, the fourth of which is to facilitate integration of diabetic services between primary and secondary care. I fully agree with him that diabetic services should be integrated into primary care. The programme the Government is undertaking to ensure the primary care teams are being rolled out around the country is important. The reality is that the focus on primary care is fairly new in our society. The Government is putting this programme in place as we speak.

In Galway roughly 16 of the 26 primary care teams have been put in place at this stage, but the integration of diabetic services into those teams is important. The other four items in the national diabetes programme 2010 are to establish a national diabetic retinopathy screening service, to establish a national diabetes register, to progress footcare services nationally and to develop strategies to improve diabetic control and risk reduction to prevent diabetic complications.

It is the policy of the Green Party — I have been involved in putting it together — that we need to increase significantly the proportion of health spend on preventative care. Indeed when I met the Finnish Minister for Health I asked her what the key issue was that fomented her country's change from having a very poor health service to a good one. She stated the key was increasing the health preventative budget from about 2% to 10%. Every government should be seeking to increase the amount of money spent on health prevention.

Diabetes has been around for a very long time. My grandmother was three years old when her mother died from diabetes in her twenties. That was something which always affected my mother, and indeed the whole family. It was always talked about. Only a few years after my great-grandmother's death insulin was discovered as a method of treatment. We have come a long way since then, thank God, but as Senator Twomey pointed out, there is still a long way to go.

One in 20 people approximately is affected by diabetes in Ireland, equating to eight Deputies and three Senators, roughly. That is probably accurate. There a number of Oireachtas Members who struggle with diabetes. Senator Twomey is absolutely right that a healthy lifestyle is crucial and that there is not enough emphasis on it. That is absolutely true and there has to be much more emphasis on that. One can criticise this Government or go backwards, but the reality is that prevention is better than cure. No Government in recent years could hold its head up high and say it had implemented a necessary programme with great aplomb.

I listened carefully to Senator Corrigan. She made some important points in relation to the work being carried out. In 2005, for instance, the health care skills monitoring report was published which examined a range of health care grades, including podiatrists. As a result of that the National Podiatry School was established in Galway. As Senator Corrigan pointed out, in 2012 the first graduates of that school will graduate. An important campaign is ongoing to ensure those podiatrists are integrated into the primary care teams around the country, and employed by the health service to emphasise that prevention being better than cure is not just a cliché but a reality.

I have examined the economics of this and Senator Corrigan talked about her area. In the Galway region between 2005-09, €11.4 million was spent on treating preventable diabetic foot disease. There were 797 patients from Galway city and county admitted for treatment for foot ulcers in that time and nearly 40% of those had diabetes. Again Senator Twomey is absolutely correct in saying podiatry is not just to do with diabetics. This is very much a lifestyle area we need to look at.

A further 73 people with diabetes from Galway had a lower limb amputation in that period. In any case where a limb is amputated relating to diabetes, that is a failure on the part of the system because the costs are going to be considerably higher if matters are allowed to reach that level. Much better screening programmes are needed. Therefore it is much more cost effective if we can treat diabetes than allowing a situation to develop whereby somebody has to have his or her foot amputated. I endorse calls to ensure podiatry graduates from Galway are integrated into the primary health care system, in line with health service and Government policy. That said, they cannot be integrated until they have qualified. Since 2005, we have recognised there is a problem and we have put in place a policy to ensure podiatrists will be incorporated into the system. Unfortunately, we will have to wait until 2012 before that happens. It is important the primary care teams are set up in such a way as to allow this to happen and everything that can be done in the interim should be done. It is a time of cutbacks but it makes economic sense to go with the policy that prevention is better than cure to ensure people get proper treatment and podiatry is put in place in the primary health care system. I endorse every effort to ensure this happens and that maximum services are provided to people who contract diabetes.

I welcome the Minister of State to the House. While I think it is important to debate this issue, I found the wording of the motion quite strange. I acknowledge the improvements in this area and the fact that a strategic policy has been developed to tackle diabetes, but I find it strange that it is the Government that intends to encourage the HSE to continue to develop and roll out the services. The Minister for Health and Children has responsibility for the HSE and it should be she who ensures this policy is rolled out. I acknowledge the work done by Dr. Velma Harkins in rolling out a policy and strategy for general practitioners and primary care services.

We have all received letters from people who suffer from diabetes. I believe the various associated conditions, such as ulcers, that eventually lead to amputations can be prevented and I do not understand how we are spending €4 million in Westmeath alone on the treatment of preventable diabetic foot disease. Of some 250 Westmeath people admitted for treatment for foot ulcers, one third have diabetes. As Senator Feeney said, much diabetes could be prevented through having a proper, healthy lifestyle. It is not difficult to have a healthy lifestyle, but education on this starts in the schools and with parents. We must educate parents on how to rear children on a healthy diet, on the importance of avoiding processed food and of taking proper exercise. Having worked in the health care area for ten years, I am acutely aware of the number of people who suffer from late-onset type 2 diabetes. This is due to lifestyle — drinking too much alcohol, eating too many processed foods and not taking enough exercise. Education on this, not through occasional advertisements on television but through GPs and primary care teams, would prevent the need for many foot and lower leg amputations.

Some people die from diabetes as a result of neglect. I agree that the worst offenders for getting themselves checked out are men. As Senator Twomey said, if we had a proper roll-out of a strategic plan, like those for breast or cervical cancer, diabetes could be detected early. It would be easy to roll out such a programme because the one blood test required could be taken when people attend for their health check-up. People identified as being in danger of developing diabetes could modify their diets in order not to become insulin dependent. I endorse what others have said and urge continuing improvements in this area. The good policies and plans that have been prepared should be implemented through the primary care system, practice nurses, awareness campaigns in schools and education of parents on providing and preparing proper food.

I and some of my colleagues are involved in the ongoing safefood programme in Leinster House and I commend the safefood team on the excellent programme it is rolling out and on its awareness campaign on television and through us. One hopes the fact that politicians are involved, as in "Operation Transformation", in trying to live a healthier lifestyle will encourage others. I, for example, have stopped taking my blood pressure tablets since I lost weight. If people modify their lifestyles, which is good for their heads and minds, take exercise, stop eating the wrong foods and stop drinking too much alcohol, they will feel better and prevent the development of conditions associated with diabetes. It is all about prevention, which is far better than cure.

It is extraordinary how much money and how many days are lost from work because of diabetes. This helps us understand the need for a screening programme. Far less money would be needed for podiatry if we had such a programme. I know how difficult it is to cure an ulcer for someone suffering from diabetes. It is almost impossible. Diabetic ulcers are very painful and I commend the nurses and doctors who treat people with such ulcers. These ulcers are preventable and I do not understand why an awareness campaign is not rolled out. One out of every 20 people in the country suffers from diabetes and it only stands to reason that the roll-out of a programme would save the country money. It would make economic sense not just to encourage the HSE but to mandate it to roll out a screening programme. This would be a wise move, would be money well spent and would reduce the number of people who lose limbs.

I cannot stress strongly enough the need for this programme. I have seen people attend clinics for months in an effort to cure their diabetic ulcers. Some of these people end up having to have toes, feet or legs amputated. Diabetes also affects people's eyesight. These problems result from neglect due to poor screening. While I welcome the developments there have been, there is much more to be done.

Ba mhaith liom fáilte a chur roimh an Aire Stáit. I welcome the Minister of State, Deputy Áine Brady. I thank the Leader of the House for arranging for this debate at my request. On several occasions in the past, not just in this Seanad but in previous ones, I have sought a debate on types 1 and 2 diabetes. Having listened to colleagues on all sides of the House, it is clear that diabetes is regarded in a serious manner, rightly so.

An elderly general practitioner told me if we could rid ourselves of the problem of diabetes we could close half of our hospitals. Many people might believe that to be a throw away remark, but there is much truth in it. Having in the past dealt in a professional capacity with diabetes I can say with much sincerity to this House that it is a huge problem. I know of three Members of the previous Seanad from this side of the House who were diabetics. Two of them have since passed to their eternal reward. They were the ones of whom we knew.

As regards heart disease, one quarter of all bypass operations are carried out on people who have diabetes. Diabetes is the primary cause of kidney failure and the commonest cause of blindness in people aged under 65. People who have been diabetic for any length of time will say they have great problems with their sight. Conditions such as gangrene of the lower limbs, the loss of toes, feet and legs are not uncommon. Diabetes is the primary cause of lower limb amputations.

A friend who is a consultant physician revealed to me today the startling statistic that 20% of people attending his outpatient department are diabetics. Another startling statistic is that a person with diabetes is five times more likely than a person who does not have diabetes to suffer a stroke or die from a heart attack. They are frightening statistics. It is said that for every type 1 diabetic diagnosed one or two go undiagnosed.

When a member of the Midland Health Board in the early 1980s a grand nephew of mine, then ten years old, was diagnosed as a type 1 diabetic. He was at that time one of ten newly diagnosed diabetics in the medical ward of Mullingar Regional Hospital. When I asked the director of community care if the incidence of diabetes was on the increase or if it was the case that we had better diagnostic facilities than was previously the case, he told me we had better diagnostic facilities. That information was incorrect because the incidence of diabetes has increased and had even at that time increased, which is in excess of 20 years ago.

Much has been said about lifestyle. Lifestyle has an integral role to play in this area and exercise is extremely important. There is common reference to obesity diabetes. Fatty foods such as crisps and fizzy drinks are considered causation factors in type 2 diabetes.

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. The plan has five key objectives: to establish a national diabetic retinopathy screening service, to establish a national diabetes register, to progress footcare 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 campaign is currently underway to improve podiatry services, which I strongly support. I warmly congratulate the Diabetes Federation of Ireland which is doing fantastic work. It is as always in the process of lobbying. Successful lobbying is lobbying again and again and, when one gets tired, lobbying again. In other words, one does not stop. This problem has such serious implications for public health, our hospital services and health resources that something must be done to ensure it is brought under control.

A national screening programme was mentioned, a worthy proposal. As mentioned by a former colleague, men are the world's worst in terms of looking after their health. It is usually at the insistence of a man's wife, partner, sister, daughter or a female friend that he goes to the doctor. Very rarely do men take action on their own initiative. What is strange is that men will have their cars serviced regularly but will not look after their own health.

A podiatry service is extremely important. I ask that the Minister of State, Deputy Brady, have due regard, through her Department, to podiatry services. Appropriate podiatry services could save people many problems. We must examine how we utilise resources. Resources devolved to the provision of a better podiatry service will in the fullness of time result in people not having to have their toes, feet or legs amputated.

Cuirim fáilte roimh an Aire Stáit, Deputy Brady. The motion, to say the least, is weak. It encourages rather than mandates the Health Service Executive and endorses, recognises and acknowledges the efforts being made in regard to public health concerns surrounding diabetes and its increasing prevalence. Senator McFadden was correct when she said in her fine address that this disease is preventable. It is unacceptable that almost one in 20 of our people suffer from diabetes. That is excessive. There is a failure on the part of Government to commit to an awareness campaign or resources.

I know people who have diabetes, some of whom have diabetic ulcers, which is distressing for them. We need to address the issue of podiatry services. Like Senator Glynn I want to pay tribute to the Diabetes Federation of Ireland, Cork for its great work. I raised the issue of podiatry services on the Adjournment Debate a couple of weeks ago. The level of amputations here as a result of diabetes is high. This problem is placing huge demand on services in Cork, North Lee and South Lee. People are being discharged from the HSE services to the care of their general practitioner, which is all fine and dandy but general practitioners do not provide podiatry services, resulting in risk to patients. There has been a reduction in staff complement in HSE Cork. Many staff have not been replaced resulting in our having fewer podiatrists to review patients with feet problems. There are fewer podiatrists to review diabetic patients' feet and, therefore, complications are increasing.

We should look at this issue from a real life perspective. All people with diabetes require a foot review but that is not happening. The discharges should not be allowed to take place because the patients are returning at a later stage with complications. That results in more misery for the patient, more cost to the State and an increase in the number of amputations. We are talking about human beings, not statistics. The motion refers to "endorses the efforts being made" and "encourages the Health Service Executive to continue to develop and roll-out models for the ongoing treatment". This is the model of ongoing treatment we are now talking about.

The expert advisory group recommended increasing the number of podiatrists and the amount of resources. I accept we are living in different economic times but can somebody explain to me how it makes sense to discharge people from a service to which they come back in at a different level that costs the State more money? That is the implication. People are not being routinely reviewed on an annual basis. They come back into the service at too late a stage, as Senator Glynn stated when he spoke about men's health. The negative side of that is that patients lose a limb through amputation and, as the Minister is well aware, the mortality rate is high in that regard. The old cliché, a stitch in time saves nine, applies in this regard. We should put in resources at a front-line level because we have an obligation to look after people.

I will give the Minister a statistic. We had seven to eight podiatrists in the north Lee-south Lee area in Cork but we have only four or five now. That is a reduction in the service being provided. That is at a time when the rate of diabetes is increasing yet we find that words such as "recognise", "endorse" and "encourage" are used in the motion. That has implications for people's personal and social circumstances. I stress the point that the people come back into the service when their condition is at a more advanced stage and with more serious complications.

In terms of the effective control of diabetes, investment in the podiatry service for patients, who are people, would lead to a massive reduction in the development and progression of complications, a reduction in the number of amputations and a reduction in the number of people seeking hospital beds, which would result in savings to the State. That is a win-win situation.

If it were not for people like Pauline Lynch and Charlotte Pearson in Cork and many other parents, we would be in a much less healthy position regarding the provision of services because we have had inadequate funding. People with diabetes have been forced into under-resourced treatment services which prolonged hospital stays and resulted in money being badly spent.

Of the 1,691 patients from Cork city and county admitted for treatment for foot ulcers between 2005 and 2009, one third had diabetes. A further 202 people with diabetes from County Cork had to have a lower limb amputated in that same period. That is a very high figure when one considers that 5% of the population suffers from diabetes.

Better use of the money we are spending in the area and a wiser approach to the patients would lead to a massive reduction in the number of people coming back into the system with complications, reduce the number of amputations and reduce the number of people seeking hospital beds. That would mean we would have a saving to the Exchequer but, more importantly, it would ensure a better quality of life for the patients who matter most.

I hope the Minister will not just take this motion as it appears on the Order Paper. It is a poor motion. In the context of what I have outlined I hope we will talk about people, not outputs and inputs.

I welcome the Minister of State. This is an area the Minister comes up against on a regular basis in terms of a policy issue, and it is welcome that there should be a debate on this important issue.

The motion refers specifically to endorsing the efforts being made to highlight the benefits of healthier lifestyle behaviours as a means of preventing this disease. The rolling out of Government policies on healthier lifestyles is as relevant as addressing the lobby groups which have been bombarding us with e-mails in recent weeks about amputations and what could and could not be saved. It is not simply a matter of addressing the consequences of this terrible condition but preventative policies, and in that regard I applaud the Government for the initiatives it has taken.

Notwithstanding the comments and the criticisms being levelled at the podiatry services across the country, I want to put on record that that is not the case in my region of Donegal, Sligo-Leitrim and west Cavan. I will deal with the specifics of that, but in reading some of the documents supplied to Members on all sides of the House about this motion, there is a reference which would support my contention that in our region at least this issue is being addressed effectively and efficiently. It states:

In relation to the quality of treatment available from the HSE and whether it differs from region to region, the short answer is "Yes — there are differences". Quality of care is good, where care is available. Across the spectrum of health issues which a person with diabetes may have . . . the problems relate to the actual existence, availability, and access to the required services rather than the quality of care. So to answer the question, it's down to waiting lists for existing services on one hand and the need to develop services where none currently exist on the other.

That is a fair assessment.

The north-west HSE region has more podiatrists than any other region in the country. The general service provided is not specific to diabetes but between podiatrists and chiropodists, they visit all of the rural clinics and, in the normal course of events and in association with the diabetic nurses, identify those who are suffering from diabetes and recommend the appropriate facilities into which they should be placed.

There is perhaps a need for a link between those who are operating on the ground and those providing the services at hospital level but on the evidence so far in my region, there is in place a very efficient service. Despite what was said earlier about the numbers of those who, tragically, undergo amputations subsequently, the condition is being picked up because of the intensive nature of the trawl and in the normal service being provided by the podiatrists and the chiropodists, certainly in my area.

I am not an expert in this area but I understand it is only the chronic cases that require amputation and that in some cases, and I do not want to stereotype people who end up with this life-threatening condition, it goes back to prevention and the person's lifestyle. To be frank, for generations those of us in this country have indulged in foods that are not in our best interests. If there is to be a focus on how to address the diabetes, it should not be one-sided. It should not be a question of just providing more podiatrists, more beds or more facilities; it should include the provision of health education. Health policies have been introduced not only by this Government but also by successive Governments over the last quarter of a century, but they have not had the desired impact. I even see it with my children. They are more likely to be stuffing themselves with fast food than eating the required daily intake of fruit and vegetables. This is a complex area. We as parents try to encourage our children to adopt a healthier lifestyle, but when Wi-Fi, the iPhone and the Sky box are competing for a child's interest, it is far easier for him or her to be a couch potato than to go out and exercise. This is coupled with their trips to the local fast food shop, or the greasy spoon as we used to call it, although I know such places have moved on a lot since then. Parents are fighting an uphill battle.

If I were to communicate just one point to the Minister of State it would be this: if we formulate a marketing campaign that is listened to by young people we can encourage this generation, at least, to start thinking about their health. When I talk about a healthier lifestyle, I am not just talking about doing the Dublin city marathon; I am talking about watching one's food intake. People need to be educated at school level. I know it is not as widespread as it used to be, but school tuck shops used to stock crisps and fizzy drinks and this was never questioned. In fact, a Member of this House — I will not name the man — who was involved with teachers argued on one occasion that such a diet was full of protein. I walked away shaking my head in disbelief that he thought that was the sort of diet schoolchildren should have — chips, crisps and soft drinks.

Companies that produce such foods also have a responsibility in this regard. I know they are in the business of making money, but it is not a coincidence that each year, coming up to the beginning of the school year, our children are bombarded daily with printed and broadcast advertisements. The major international retailers start to run promotional weeks in which a number of packets of crisps or fizzy drinks can be obtained for a couple of euro. These are linked, rather cleverly, with some sort of school scheme in which, for example, if children buy crisps or fizzy drinks they get free copybooks. There is a need for joined-up thinking in this regard. We should be addressing the issue of lifestyle as well as filling the gaps in the provision of services.

Health professionals in my region are doing a good job identifying potential candidates for amputation and acting quickly to save them. I commend HSE North West in this regard and I commend the motion to the House.

I welcome the Minister of State and the opportunity to debate the issue of diabetes. There is, as the motion states, a great deal of public health concern about diabetes and it is a major issue for the health service. As others on this side of the House have pointed out, the motion is flawed. It is a rather bland motion with little of substance to say about the need for health education and awareness campaigns about diabetes. It simply acknowledges public health concerns, recognises work already being done, without saying what it is, and endorses efforts being made to highlight the benefits of a healthy lifestyle, while encouraging the HSE to continue to develop models for ongoing treatment and management of diabetes, without saying what these should involve.

We all know somebody who has diabetes. The condition has various types, each with a different prevalence, as the Minister of State is aware, from insulin-dependent diabetes, in which people must inject themselves with insulin every day, to a much less intrusive version. In recent weeks we have been receiving many e-mails about a particular aspect of diabetes, namely, the cost of diabetic foot disease. We have all received letters from the Diabetes Federation of Ireland, which I thank for bringing this to my attention. It was not an aspect of diabetes treatment about which I was knowledgeable.

We all acknowledge that, as Senator Mooney said, there are significant issues with regard to the prevention and treatment of diabetes and particularly the promotion of healthier lifestyles. However, on the issue of diabetic foot disease, which we are here to discuss, the particular problem that was brought to my attention by the campaign run by people with diabetes is the inadequacy of podiatry services available to diabetics. There have been a number of pronunciations in the House. Podiatry is the branch of medicine which deals with lower legs and feet. About 50% to 60% of the work of HSE podiatrists is connected with diabetes. We know that adults with diabetes are prone to nerve damage in their feet and legs, and that infections in those with diabetes can easily become leg or foot ulcers. We have done some research on this within the Labour Party, and I am staggered by the cost to the health service of the treatment of such ulcers. This is an issue that is perhaps not uppermost in people's minds when they talk about diabetes treatment, but it is a major issue for people with diabetes. Six thousand cases of foot or leg ulcers were recorded by the HSE between 2005 and 2009. Each of them cost €30,000 to treat, with patients staying in hospital for an average of 35 days, and a staggering 1,500 of these ulcerations led directly to lower limb amputation. Thus, inadequate podiatry services have real consequences for people with diabetes, and that is why this campaign is being run.

As my colleague Senator Prendergast, the Labour Party health spokesperson in the House, pointed out, last month's HSE report on diabetes showed a decrease in the prevalence of foot ulcers for patients with both type 1 and type 2 diabetes which represents considerable progress and can be attributed to the implementation of an evidence-based foot care protocol and a limited increase in the number of patients undergoing regular foot assessment and review by a podiatrist. However, although there have been developments in the treatment and management of diabetes, including this particular consequence of diabetes, Ireland still lacks a comprehensive foot screening programme. The Diabetes Federation of Ireland has called for such a screening programme, which it says will reduce the number of foot ulcers and resulting lower limb amputations caused by poorly managed and in many cases undiagnosed diabetes.

The introduction of such a programme would bring massive benefits to all involved, particularly those unlucky enough to be diagnosed with diabetes or whose conditions go undiagnosed until they manifest in the sort of foot conditions about which we are speaking. An investment in podiatry services would reduce the number of avoidable complications, which in many cases lead to prolonged hospital stays, long periods of immobility or amputation. In many areas, patients are being subjected to undue suffering that could be avoided if we had adequate podiatry services and better provision of such services across the country. The focus of some e-mails I received has been on particular areas such as north Dublin city and county, but we need to ensure there is a consistent level of treatment available across the country.

Adult-onset or maturity-onset diabetes, known as type 2 diabetes, usually develops slowly in adulthood. With an average of seven years between onset and diagnosis, the earlier the condition is detected, the easier it is to reduce the risk of long-term complications. Even with our focus on ulcers and infections of the feet, it is important not to lose sight of other serious consequences of diabetes, such as heart attack, stroke, kidney failure and eye disease — the latter a consequence of diabetes with which I am more familiar. Not only does the lack of an extensive treatment programme cause undue suffering for patients, but it has a serious impact on ongoing costs due to the necessity of intervening later when conditions such as eye disease have become much more serious. We spent €239 million treating preventable diabetic foot complications between 2005 and 2009. The Diabetes Federation of Ireland has estimated that we could reduce the inpatient cost of treating diabetic foot disease by between 50% and 70% after five years by investing more at an earlier stage on an adequate treatment programme on foot complications from diabetes. It would make sense to reduce the amount of money we spend on treatment by preventing the onset of diabetic foot complications and by ensuring we have a decent screening programme and follow up service. A modest investment of just €1.56 million per year could provide a nationwide screening service leading to less suffering for people diagnosed with diabetes and a lesser ongoing cost for the HSE. Not investing in podiatry services represents a mismanagement of available resources when the consequences to the individual patients and their families, and the health service generally are so severe. We have a chance to improve our health service at a relatively low cost which will represent a long-term saving to the Government. It is of utmost importance that the Government acts on the issue rather than just paying it lip service.

In 2012 I understand Ireland's first podiatry students will graduate from NUI Galway and we hope they will not need to follow other graduates who will be forced to emigrate when we could do so much with their expertise at home.

I welcome the opportunity to take part in this debate. I regard myself as very lucky to do so because it had not been on the programme that we would be meeting at this time. When it was rearranged I had several other engagements, all of which I have just managed to fulfil. I have just come hotfoot from Trinity College where I was introducing a very important Italian film regarding that country's attempt to do what this House did recently, which is to introduce a civil partnership Bill. While I was unable to see the film I came straight down here because like many of my colleagues, I was contacted by a large number of people with concerns in this area. I delayed replying to all of them, because it was a real flotilla ofe-mails and messages until we had this debate so I could refer them to it as I believe they will be heartened by what has happened tonight.

I commend Fine Gael and the Labour Party for not amending the Government motion, which represents a positive approach without the usual mean-minded Wednesday evening tit for tat point scoring. I believe that was partly because the Government worded the motion sensitively and in a non-confrontational manner on which I compliment it also.

Instead of contacting all the people who sent me e-mails I went to the source of what I thought would have been the best information. As it may very well be that my colleagues also had access to this, if I am repeating things already said, I apologise. I wrote to Mr. Kieran O'Leary, the chief executive officer of the Diabetes Federation of Ireland. He wrote back explaining that it wished to engage in a programme reducing the number of costly foot ulcers and lower limb amputations. I am sure very few of us would have realised that diabetes can lead to a situation not entirely dissimilar to the appalling scourge of leprosy. As a result of the impact of diabetes particularly on the lower limbs the nerves become desensitised and as a result patients with diabetes when they reach this point may very well be unaware of what are initially minor abrasions, scrapes cuts and so on, which can become infected and a major source of ulcers leading to gangrene followed by the amputation of the lower limbs. That is an extraordinary progression from a minor graze to the amputation of a leg, which is almost invariably followed by the amputation of the second leg, which in a large number of cases is fatal. Therefore, we are dealing with a fatality that comes from something fairly minor.

I encourage anybody who may be involved in this situation to go to the website because the information there is very clear, accessible, simple and practical. It deals with, for example, examination of the foot, particularly by elderly people. It also refers to the use of professionals because sometimes if people, particularly elderly people whose eyesight may not be good, attempt to rectify a problem such as overgrown toenails, they can without noticing it inflict a wound that may become a serious problem for them. The website recommends first of all inspection, not just to use one's own skills but to seek where possible professional assistance in chiropody etc. and then to maintain a strict regime of hygiene and the use of ointments and so on.

While I do not have diabetes, as I grow older I find I have some of the exact symptoms being described on the sole and ball of the foot. Particularly if one wears sandals in the summer the skin can become calloused and hardened. I have had extremely painful splits in the hard tissue that builds up. It is comparatively easy to treat; in the past year I have got a couple of little instruments. In the bath the skin gets softened and one can scrape it off, which avoids the situation which is merely uncomfortable for me but could be serious, dangerous and possibly even fatal for people with diabetes. That is the humanitarian thing — the avoidance of suffering.

I am sure the Government will be open to the very clear financial argument, some of which has been sketched out as I just heard in the end of Senator Bacik's speech. It is very telling that the costs can be reduced by this simple foot-screening programme. Approximately 6,000 foot or leg ulcers were recorded by the HSE between 2005 and 2009 each of which cost between €9,000 and €30,000 to treat. Each patient stayed in hospital for an average of 31 days with 1,500 patients having ulcers, which are prone to gangrene, leading directly to a lower limb amputation in the same period. The statistics then become even more worrying. Some 70% of people who lose a limb in this manner will lose the other leg via a contralateral amputation within 18 months. Some 40% of people who lose a leg through amputation die within five years — a worse survival rate than for breast cancer.

Some €239 million was spent treating the complication of diabetic foot disease between 2005 and 2009. A national screening programme costing only €1.65 million per annum could save from 40% to 70% of the treatment cost within three years. We are in a state of budgetary restrictions with everything being cut back. Here is a programme which will save people from misery, save lives, maintain the good health of citizens, particularly the elderly, and will save perhaps up to €100 million for the Exchequer.

This is a very welcome motion that is practical, simple and capable of being acted upon. Obviously the motion has the support of the Department of Health and Children or else it would not have made it onto the Seanad Order Paper from the Government side. I ask the Minister to give some assurance that such a foot-screening programme will be introduced as soon as possible and I ask her to give a timescale for doing so. If there is any disagreement with the Department of Finance, the record of the debate in this House should indicate a significant saving for the Exchequer. We can do the right thing and save money as well as saving people's lives and improving their health. It represents that unusual phenomenon in these difficult days of a win-win situation.

I will use the opportunity to add to what has been said in support of the motion. It is welcome that the focus is being placed on the issue of diabetes tonight and it is appropriate and opportune that we are having this debate. I do not have diabetes, but my nephew who is my godson was diagnosed with it a number of days ago. Therefore, I am aware of the difficulty it causes for him as a young adult.

Diabetes is a medical condition the incidence of which is increasing in the population. I commend the Diabetes Federation of Ireland for the work it has done. I also commend the Donegal branch of the federation; its chairperson, Mr. Danny McDaid, whom I know, and all the people involved who are doing outstanding work in raising awareness of diabetes and campaigning and fund-raising to finance the activities the federation undertakes.

The research carried out by the federation was mentioned by other contributors to the debate. It shows that 5% of the population have diabetes and that this figure will increase by 37% in the next ten years. A total of 10% of the health care budget was spent on the treatment of diabetes in 2008, with 60% of the €1.6 billion being spent on dealing with diabetes complications. I was taken aback when I saw that statistic in the research. Worldwide, a limb is lost every 30 seconds due to diabetes. The risk of amputation is 20 to 40 times higher in patients with diabetes. A total of 338 people with diabetes had a lower limb amputated in 2008, at a minimum inpatient cost of €1.1 million. This does not include other expenses such as the cost of antibiotics and wound dressings; ongoing direct outpatient, social welfare and housing alteration costs, as well as the many other costs associated with this procedure. When added together, the final cost to the Exchequer is huge and unnecessary. In addition, there are the costs relating to those patients who require treatment for foot ulcers but who do not require an amputation. The five year mortality rate for patients who have had a limb amputated is significantly higher than that for patients who have had breast or prostate cancer surgery, a fact Senator Norris mentioned.

The Diabetes Federation of Ireland has proposed a model of care which would identify those at risk of amputation as a result of diabetes. A pilot project being funded by the federation in Galway suggests identification of an at-risk foot ulcer does not require intense training or high tech equipment. The screening assessments can be easily performed in 15 to 20 minutes by trained practice nurses during the patient's annual check-up as part of an integrated model of care which would allow easy referral, where necessary. To date, 580 patients have been screened as part of the study, with 15% being categorised as high risk, requiring appropriate follow-up action. One podiatrist assigned to the local diabetics clinic is co-ordinating practice nurse training and managing referral pathways. The authors of the motion might have had this study in mind when they were framing it because this is the type of development envisaged in the final part of the motion which refers to models for ongoing treatment and management of the disease and its complications.

I support the motion and the focus on the issue of diabetes. However, with regard to the pilot scheme, will the models for ongoing treatment and management of the disease and its complications be put in place? We must consider this in the context of the current financial situation. It certainly will not happen if the Minister for Health and Children, Deputy Harney, and her Government colleagues have their way with regard to the €600 million to €1 billion to be taken out of the health budget in December. I commend Fianna Fáil Senators for proposing the motion, but if they are sincere, they must oppose the health cuts which can only result in misery for diabetes sufferers and patients throughout public health services.

I am glad I have had an opportunity to contribute to the debate. There is no proposed amendment to the motion which is only right as there is good work being done on the issue. A great deal of State money is being spent, but more work could be done. In that regard, the Diabetes Federation of Ireland has led the way. Let us consider positive actions that would result in a saving for the Exchequer and, more importantly, will ease the pain, discomfort and difficulties suffered by those who have contracted diabetes. It would be a benefit to the patient, the health service and the State.

I welcome the opportunity to speak on the subject of diabetes. Diabetes mellitus is a chronic, progressive metabolic disease. There are two types of diabetes. Type 1, or insulin dependent diabetes, accounts for approximately 10% of cases and affects mainly children, adolescents and young adults and requires lifelong treatment with insulin. Type 2, or non-insulin dependent diabetes, accounts for 90% of all cases diagnosed in Ireland and affects mainly middle aged and older people. Its prevalence is rising rapidly owing to a number of factors, notably the ageing population, dietary habits and more sedentary lifestyle behaviour leading to obesity.

Approximately one in 20 people in Ireland has diabetes. A report, Making Diabetes Count — What Does the Future Hold?, published by the Institute of Public Health in 2005 estimated that over 140,000 adults in the Republic of Ireland had diabetes. It predicted that this figure would continue to rise in the coming years. The institute also estimated that over 10% of Government health care spending was diabetes related. It is worth noting that an estimated 90% of type 2 diabetes and 80% of coronary heart disease cases in the population could be avoided by healthier lifestyle behaviour such as eating a healthier diet, engaging in more physical activity and stopping smoking.

My Department recently launched a new cardiovascular health policy. I am glad prevention and health promotion measures are given particular prominence in this policy report. The recommendations in the report cover organised societal and public policy efforts to tackle smoking, diet, exercise and alcohol misuse, all contributory factors not only for cardiovascular disease but also for diabetes. It is clear that people need to be encouraged to take more responsibility for their own health. A central message is the need to increase awareness of the risks lifestyle and behaviour pose to health and the measures to help patients with diabetes to improve and prevent the onset of complications.

I will now deal with the risk factors that contribute to the incidence of diabetes. Learning to take responsibility for one's health requires a combination of factual knowledge and adopting appropriate values. Regular physical activity reduces the risk of developing chronic illnesses such as diabetes. Research shows that most Irish people are not as active as they need to be to maintain good health. The national survey of lifestyles, attitudes and nutrition, SLAN 2007, revealed that only 41% of Irish adults took part in moderate or strenuous activity for at least 20 minutes three or more times a week. Over one fifth of Irish adults, 22%, reported being physically inactive. This is a cause for concern. It is little surprise, therefore, that the same survey found that 38% of Irish people were overweight and a further 23% were obese.

In June 2009 I launched the national guidelines on physical activity which emphasise the importance of physical activity to overall health and well-being and give clear information on the recommended levels of physical activity required for different sectors of the population. The key message is that physical activity is for everyone and that any level of activity is better for one's health than none. The guidelines recommend that adults should be active, at moderate to vigorous levels, for at least 30 minutes five days a week.

The Department is in the process of concluding a revision of the food pyramid and healthy eating guidelines in an effort to help increase people's awareness of their nutritional requirements and the type of food and portion sizes required for good health. Little Steps, Food Dude and Walk to School Wednesday are examples of education programmes that raise awareness among children and adults.

We in Ireland drink too much alcohol. Apart from the many social harms caused by alcohol, it is a leading contributory factor in many medical conditions. It increases the risk of many diseases even at low levels of consumption. Alcohol consumption can make it difficult to recognise the symptoms of low blood sugar. Diabetics need to be careful with alcohol.

People with diabetes are three times as likely to die of cardiovascular diseases. Smoking and diabetes together substantially increase the risk of a heart attack or stroke. Smoking rates in the population still remain persistently high at 29%. In an effort to tackle these smoking levels, the Department has introduced several legislative measures to reduce the initiation and prevalence of smoking. These include the workplace smoking ban, a ban on the sale of ten-packs, a ban on in-store advertising and the display of tobacco products, a requirement that all retailers be registered and curbs on premises where self-service vending machines are permitted.

It has been estimated that up to half of those who have diabetes are undiagnosed. It is crucial that people are aware that diabetes is a disease which can be managed and many of the complications prevented. If an individual is concerned, they should seek medical advice because in many of these lifestyle diseases time is of the essence. The earlier diabetes is diagnosed, the better the prognosis.

Diabetes has a profound impact on lifestyle, work, well-being and life expectancy. Diabetes also causes vascular complications resulting in coronary heart disease, stroke and peripheral vascular disease which are the main causes of premature death for people with diabetes. Diabetes is the commonest cause of blindness and amputations in the working population. Foot problems are a common cause of diabetic admissions to hospital.

Many patients with a chronic condition such as diabetes do not require hospital admission but can be managed in the primary and community care settings if the appropriate support is available and agreed protocols and pathways are followed. This also applies to self-management and support. It is important in this challenging economic climate that patients receive the best treatment possible in the most cost-effective manner.

In 2006, the Department of Health and Children published a policy report on diabetes, Diabetes: Prevention and a Model for Patient Care. This set out a model of care based on shared care between primary care and acute services which would deliver quality diabetes care at the appropriate level.

The Health Service Executive established an expert advisory group to implement the policy recommendations. Its report was launched in November 2008. A key element was the publication of integrated care guidelines which represented a new way of primary care and acute specialist services working together to reduce the burden of this condition. The group emphasised real savings could be achieved in health care costs by preventing the complications of diabetes. These would be achieved through patient education and empowerment, primary care linked to specialist secondary care and special provisions for early detection and treatment of any complications that would develop. In this shared care model, roles and responsibilities are clearly understood and it is supported by agreed protocols. Such care has been shown to be particularly effective for the management of type 2 diabetes.

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: 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 been appointed recently to take the lead on the diabetes clinical programme. He is engaging with all stakeholders, including the Diabetic Federation of Ireland, clinicians and podiatrists, to establish a multidisciplinary package for diabetic patients.

General practitioners are competent in managing diabetes and 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 such as peripheral vascular disease. The aims of the podiatry service include maintaining mobility and independence in older people through assessment, treatment, education and support in a clinical and home environment and the education, assessment and care of diabetic patients to prevent complications of the foot.

The HSE provides a podiatry service for medical card holders. Patients requiring podiatry assessment and treatment may be referred from GPs, primary care team members, diabetes services and hospital services. Several initiatives have been undertaken recently such as the development of a standardised podiatry assessment tool for diabetic patients. This will enable referring GPs and practice nurses to give the podiatry department an accurate assessment of the status of a diabetic patient's foot condition which will in turn ensure the department can identify and prioritise high-risk diabetics and provide timely intervention as required.

Services may be provided by chiropodists and podiatrists employed directly by the Health Service Executive. Chiropodists and podiatrists are also contracted under the General Medical Services scheme. These provide services on a sessional basis for clients eligible under the scheme. Chiropodists and podiatrists who undertake these sessions are taken from the list of approved chiropodists and podiatrists who have been assessed as eligible to practise in the public health service.

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 together to improve provision and access to podiatry services for people with diabetes.

The expert advisory group in its 2008 report identified retinopathy as one of the commonest serious complications of diabetes. Among its key recommendations was the introduction of a diabetic retinopathy screening programme to prevent eye disease. Retinopathy national screening has been identified as a priority for the national diabetes programme. As Senator Mooney noted, a pilot project has been in operation in the north west for several years. Extending that programme beyond the north west is a priority for the Health Service Executive. An implementation model is being developed by the HSE and it is hoped that implementation will commence in 2011.

It is vital to improve the quality of life for people with diabetes. At the same time, the risks of people getting the condition and the onset of complications in those who have it need to be reduced. The Health Service Executive, through the new national diabetes programme, is progressing a national delivery plan which will provide a blueprint for the delivery of services for patients with diabetes over the coming years. Putting a greater focus on prevention is the most cost-effective and sustainable intervention we can make.

I thank Senators on all sides for their positive and sincere contributions in this debate. It is not often we sing from the same hymn sheet as we did during this debate. As the Minister of State said, diabetes preventative measures must centre on lifestyle. Everyone must be responsible for their health and lifestyle, maintaining healthy eating, reducing alcohol intake and taking regular exercise.

Senator Twomey referred to having a plan for patients who develop diabetes. GPs would be their first port of call and most primary care centres now have practitioners of those other disciplines that can help in the treatment of diabetes.

It is important to raise people's awareness of the symptoms of diabetes. An effective way of doing so is through advertising campaigns on television and billboards. People need to be aware that frequently feeling thirsty could be a sign of developing diabetes. We associate blood pressure and high cholesterol with other conditions and perhaps we do not put them down to diabetes often enough. We should educate people in this regard.

Investment would yield an excellent return to the State and the Government. The Minister of State referred to the need for GPs to be armed with what is needed to control, maintain and look after a person with diabetes and the need for agreed protocol and pathways to follow. The Minister of State should consider seriously the potential of the College of Podiatry in Galway, which has been discussed this evening, and of its graduates which we hope will emerge in 2012. We must ensure we get them into the HSE or the workforce where they can take care of patients. We must keep this issue high on the agenda. We debated it last year and perhaps we should revisit it again in nine months. I thank everyone for their contribution.

Question put and agreed to.

When is it proposed to sit again?

Tomorrow at 10.30 a.m.