The shortcomings in our health service have provided us with some horror stories over the years.

However, few can be as grim as the prospect of diabetes patients losing their limbs or going blind -- due to official neglect.

Shock figures released this week show that lack of action by the health authorities on providing adequate screening and early treatment causes at least 270 people with diabetes to lose their lower limbs each year through amputations that could have been prevented.

In addition, more than 80 people with the diabetes-related condition retinopathy who have sight loss are referred to National Council for the Blind Services each year.

Lack of proper screening is a big factor in this condition as well.

MYSTERY

Diabetes affects around one in 20 Irish adults.

Many people with diabetes get complications such as circulatory problems in their lower limbs or retino-pathy in the eyes, which if not caught early and treated properly, can have catastrophic disabling consequences.

The health authorities have known for years that there are relatively simple solutions to preventing severe disabilities in people with diabetes but have done little or nothing about it.

The puzzling thing is that the solutions proposed are relatively simple and extremely cost-effective, in addition to having the incalculable benefit of saving people's limbs or sight.

So it is a bit of a mystery, but perhaps not surprising given their record to date on preventive healthcare, that the health authorities have not acted on this crisis.

The Diabetes Federation has pointed out that the hospital service already spends €30,000 per patient to carry out largely avoidable amputations due to diabetes complications, adding up to a total of €1.1m per year.

Added to this are further outpatient, social welfare and housing alteration costs.

Simply appointing a sufficient number of podiatrists to screen and treat diabetic foot problems in hospital clinics and in the community would, the federation points out, avoid may unnecessary amputations.

This would cost only €1.5m and would have huge longer term cost savings, as hospitals would no longer have to perform as many amputations.

A huge problem in this area is the shortage of podiatrists in Ireland. There are only for or five fulltime podiatrists in the country dealing with diabetes patients.

If you want a snapshot of how poorly resourced our health service is, that figure really speaks for itself.

A major problem has been that Ireland only got a school of podiatry last year.

As regards preventing sight loss in diabetes patients, Ireland does not even have a national screening programme to detect diabetic eye disease.

Again, this is a story of broken promises.

A pilot programme (for the west of the country only) was finally promised for this year but has been delayed until next year.

With the current state of health funding, it is surely by no means certain that it will go ahead in 2010.

And what's more, an eye screening programme is needed nationally, not just in the west of the country.

A national eye screening programme would only cost €4m but would save the health service far more in terms of the future cost of looking after people with sight-loss.

It beggars belief that these basic services for diabetes patients were not put in place in economically better times.

Now the HSE is planning to do something about the health complications of diabetes.

kitty

The problem is there is not extra money in the kitty, even though only a paltry amount is required for a huge dividend in service and quality of life improvements.

It is to be hoped that the HSE comes up with real solutions that focus on optimal patient care and not just budget-balancing.

Hundreds of people are having to cope with major disabilities due to State penny- pinching.

How many more diabetes patients will lose limbs or their sight before the health authorities finally do something about it?

Niall Hunter is editor of irishhealth.com

- Niall Hunter