Ireland’s Health System Slammed Regarding Diabetic Foot Care

A Call for Diabetic Footcare, Nationally

[Posted: Sat 11/09/2010 by Niall Hunter, Editor –]

A new diabetes campaigning group has claimed the HSE has spent €240 million on hospital treatment of diabetes complications it could easily have prevented developing.

Over 300 people every year have to undergo foot amputations as a result of developing diabetes complications

The new group, Diabetes Action, says failure to develop specific health policies to manage diabetes care has led the HSE to spend over €239 million on in-patient costs treating largely preventable complications of diabetic foot disease between 2005 and 2009.

Diabetes Action today launched a national “Half the Services, Half the Care” campaign in a bid to influence Government health policy, which it says is failing to provide targeted services and care for the growing number of people in Ireland who have diabetes.

Dr Ronan Canavan, consultant endocrinologist at Dublin’s St Vincent’s Hospital said as a result of undiagnosed and poorly-controlled type 2 diabetes, people are needlessly developing foot complications, like ulcers, which too often lead to lower-limb amputations.

Between 2005 and 2009, 1,579 people with diabetes in Ireland underwent a below-knee amputation and nearly 6,000 people with diabetes developed a foot ulcer requiring in-patient treatment, he said.

Diabetes Action says Ireland has the lowest level in Europe of podiatrists, who provide foot care for diabetes patients.

It adds that there is no system in place to identify or track at-risk people to ensure preventative measures are taken to stop diabetic foot complications before they can develop.

“Half the Services, Half the Care” is calling for 20 podiatrist positions nationally to work with people with diabetes and provide a national screening programme – the annual cost of these positions is just €1.56 million.

Diabetes Action says the service would pay for itself on the basis of each podiatrist preventing only three in-patient foot ulcers treatments each year.

“The cost of treating diabetic foot disease in Irish hospitals is staggering – €239 million only covers the direct inpatient hospital costs – it doesn’t take account of the cost of dressings, antibiotics or social welfare – to say nothing of the personal costs of periods of immobility or loss of earnings. Our figures also indicate that close to 50% of people with diabetes who undergo a lower-limb amputation are of working age” according to Dr. Canavan.

He said the HSE was not channelling the financial and human resources in the health system effectively to tackle diabetes.

“This year, €580 million will be spent on diabetes care – 60% of that figure will be spent on treating preventable complications. A national strategy for diabetes would dramatically reduce inpatient costs and result in better health outcomes for people with diabetes.”

A HSE diabetes audit carried out in the midlands, published this week, recorded a significant decrease in the prevalence of foot ulcers for patients with both type 1 and type 2 diabetes* (2.5 % in 2009 compared with 6.1% in 2003).

This improvement can be attributed to the implementation of an evidence-based foot care protocol and increased numbers of patients having a regular foot assessment and review by a podiatrist, according to Diabetes Action.

“Half the Services, Half the Care” is calling for HSE resources to be redirected to provide a cost effective national foot screening programme which would identify people with an at-risk-foot.”

The campaign is stressing that an annual check-up for people with type 2 diabetes could reduce the cost of treating diabetic foot conditions by as much as 50% and potentially save the HSE over €115 million over a five- year period.

Diabetes Action has also launched its website The website is a targeted campaigning tool for the public to use during the two-year “Half the Services, Half the Care” advocacy initiative.

Diabetes allows people to contact their local politicians about local, regional and national health services which affect people with diabetes and asks politicians to lobby the HSE to develop and implement a National Diabetes Strategy.

The campaign group has been set up by the the Diabetes Federation of Ireland, with diabetes consultant and nurse specialists.

*In type 1 diabetes patients there is a complete lack of insulin in the body and people with this type of diabetes must have regular doses of insulin every day.

In type 2 diabetes, which is often linked to being overweight, there is usuallty an excess of insulin and the insulin in the body does not work effectively. This group comprises the majority of diabetes patients.

Those with type 2 diabetes generally have their condition managed through diet or or oral medication, although some will require insulin.

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