Mr. David Keegan:

I was going to deal with that a little later but I will answer it now. The key point about the strategy is that it is a cohesive approach. The national eye care programme looks at hospital eye services and community eye services. It was tasked with doing that through the clinical care programme overseen by Dr. Áine Carroll. Mr. Paul Moriarty, the national clinical lead for ophthalmology, has drafted that document. Ms Siobhan Kelly, from the Irish College of ophthalmology, is here - I was speaking to her this morning. That document is just ready to be published. It document oversees the immediacy in hospital services and community eye services.

What the strategy seeks to do is to build in a full longitudinal care plan, right from when somebody needs to go to his or her optician for glasses to the stage if, unfortunately, he or she has to attend the NCBI Fighting Blindness, guide dog services or Child Vision with cane or guide dog. The strategy also manages to fold in as it were, much like Deputy Catherine Byrne's comment about the holistic approach. This is a patient-centred approach. The individuality of those with sight loss and blindness is protected or cared for under this strategy as well.

Also dealt with within this strategy is the importance of research. It is well known around the world that best outcomes happen in countries that adopt or embrace a research culture. If countries are open to research, they are more likely to adopt best evidence medicine and to do so quickly. Those countries that do not have research at their core do not adopt it and, therefore, one does not get better patient outcomes. That is something that has been seen in the cancer area in this country also. The strategy incorporates the eye care plan but it brings in the extra components that all the stakeholders here represent.

I agree on the multidepartmental issue. It was one of the startling findings for me when we did the cost of blindness study. I was not expecting this. I thought the cost of blindness would highlight, much like the cost of sight loss did, a lot of the costs in and around health care, but this transcended so many different departments. The impact became immediately obvious, not only on the health services but on the Department of Finance through both the reduced tax take because fewer persons with vision impairment or blindness are active in the working community - there are notable exceptions - and the dead weight loss because where one transfers those payments from those who are paying taxes to those on the welfare side there is a leakage. The Department of Social Protection provides payments, such as the blind pension and the social welfare payments associated with those with vision impairment but also the supports for those affected because more of them are out of work.

Following on from that, there are also those informal care costs because there is the assistance and help that those with a vision impairment or blindness require. We are lucky in this county we still have a good social and family fabric, but there is the lean on the time of that network. Their productivity reduces and there is also the result of a friend, colleague or family member being affected by vision impairment or sight loss. That is one of the hidden costs in and around this. I stress that is a financial cost. The economic cost is more startling, but I felt in this environment it was not relevant or, necessarily, the best way to present that data. The economic cost is over €1 billion, but that factors in loss with respect to well-being. When one factors in the other costs it becomes an even more staggering figure. These are the financial costs that we talk about.