Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

-----although we must never forget the importance of taking personal responsibility for our own health.

The projected growth in incidence of chronic disease risks leading Ireland into an unhealthy and costly future. Action is required to create change and try to address these negative health trends before our problems grow larger. In particular, we need to increase the proportion of people who are healthy at all stages of life. Healthy Ireland draws on the existing policies but stresses the importance of effective co-operation and collaboration in order that we implement evidence-based policies. It is about each individual sector helping to improve health and well-being, multiplying all efforts and delivering better results. These are the principles that we bring to addressing the issues highlighted by today's Private Members' motion.

I acknowledge the very useful contribution made by the Cost of Sight Loss Report, commissioned by National Council for the Blind in Ireland. It certainly adds to our understanding of sight loss and its implications for individuals as well as for society as a whole. It is very good example of how we need to understand the impact of ill-health and disability on society. This study estimated the direct and indirect costs of vision impairment and blindness in Ireland at more than €380 million in 2010. It also estimated that at that time there were more than 220,000 people in Ireland living with low vision and sight loss.

I have been Minister for Health for only a short number of days and I have made it clear that I want to spend the next few weeks talking to people, listening to what they have to say, reflecting on what I find and then I plan to focus on some achievable priorities. Nevertheless, I can say clearly that I want to make primary care the cornerstone of our health service. The Government is committed to the development and implementation of a new primary care strategy. This will be based on best evidence and best international models but also on the many examples of excellence that I know can be found already in our own service. There will be renewed focus on prevention and early intervention, the promotion of responsibility and self-care in the management of chronic disease, the provision of care and rehabilitation in the community and close to people's homes. It must be fully integrated with secondary and more specialised care, which people need from time to time. I stress this because these principles are important to the provision of an appropriate service delivered in appropriate settings and by appropriate professionals for the prevention and management of diseases that affect vision, just as they are with the majority of other common chronic diseases and disabilities.

A further issue is integrated workforce planning, in other words, the development of people and roles for a wide range of professional services. Existing structures do not fit the aspirations of this decentralised model. The health workforce needs to be developed and refocused to deliver a greater proportion of care in the community. This will require the development of multidisciplinary teams which, in association with the ophthalmologists, include, for example, specially trained nurses, optometrists, orthoptists and ophthalmic technicians. In this way teams will be able to organise the workload such that, for example, children referred from school screening are seen by an orthoptist in the first instance. Children with refractive errors will be seen by an optometrist. Refining the number of children to be seen by the doctor will release a substantial amount of medical time for eye doctors to diagnose and treat more complex cases in both child and adult populations.

I recognise the work of those involved in the HSE's national clinical programmes on ophthalmology and diabetes. They are good examples of the necessary clinical leadership which is so essential to sustainable reform of our health services. I am looking forward to seeing this in action for myself. I understand that they have the central objective of developing care pathways and referral protocols for the prevention and management of the principal eye conditions, to be implemented through a decentralised community-based care model, with pathways of referral into acute hospital services and back to the community where clinically appropriate. The HSE's national clinical programme on diabetes, which includes the care of children and adolescents with diabetes, was established in May 2010. The purpose of the programme is to save the lives, eyes and limbs of patients with diabetes. From the outset a priority objective was to develop a national retinopathy screening programme. Systematic retinopathy screening on a population basis is clinically effective in identifying treatable eye disease and is cost-effective. Diabetic retinopathy screening commenced in March of last year. This offers free, regular diabetic retinopathy screening to children from age 12 and to adults. Currently, there are some 145,000 people on the Diabetic RetinaScreen register. By the end of June 2014, 109,000 people had been invited to participate in the screening programme. The programme is on target to invite all eligible participants for screening by the end of this year.

Eye health services provided through the public health service are provided free of charge to children and to medical card holders of all ages. Patients with the greatest clinical need are prioritised and treated as soon as possible. However, waiting times for routine referrals are currently over a year in some parts of the country, as was mentioned by Senators earlier. Consequently, the HSE is establishing an expert group to carry out a review of HSE ophthalmic services. It will review what is currently provided and conduct an analysis of resources, including budgets and workforce. The review will draw up a national plan for the service, which will identify any current inadequacies and inconsistencies and how these should be addressed.

People with disabilities, including blind and visually-impaired people, can access specialist disability services, which are provided in a variety of community and residential settings. These may be provided directly by the HSE or in partnership with voluntary service providers, including the National Council for the Blind and the Irish Guide Dogs. I recognise the enormous contribution that these organisations and their staff and volunteers provide to the care, dignity and life experience of those who depend on their services.

I have outlined the breadth of health service provision aimed at protecting people's eye health and, where necessary, providing supports to people with visual impairment. It is based on the goals and principles of Healthy Ireland, rooted in primary care but integrated with and supported by secondary and specialist services for those who need them.

On the particular call for a national vision strategy on top of the existing national programme for eye care, I am certainly happy to give it detailed consideration. I want to issue a word of caution, however. I am only about five days in office as Minister for Health and I have already come across an awful lot of strategies, very few of which I have had a chance to read yet, and I am not sure when I will get a change to read them - it will probably be on the Camino in August. Of those I am aware of already and those that I have read, they are, by and large, behind schedule in terms of implementation and, in large part, seem aspirational.

I am reluctant to expend time and resources developing new strategies only to publish them, launch them amid much fanfare and leave them on the shelf to gather dust. I do not think that serves the interest of anyone interested in health and disability.

The Government remains committed to the provision and development of vision services and supports through health prevention, screening and intervention policies and programmes, all of which contribute to addressing the priority goal of the World Health Organization's Vision 2020 initiative, namely, to eliminate avoidable blindness. Once again, I thank Senators for proposing this motion. I will give its contents full and detailed consideration over the coming weeks and months and I can confirm that the Government will not be opposing the passage of the motion in the House.