Dr. Laura Noonan:

In response to the question of whether there are structures in Ireland for that, there are not. If we look at international data, however, there are structures that support that. For example, the CARE Plus study in Glasgow is an intervention that comprised of structured longer consultations of 30 minutes to 45 minutes, relationship continuity where a patient saw the same GP repeatedly, practitioner support where the GP was given extra supports to deal with patients with multi-morbidity, and patients were given important self-management support putting the patient in charge of his or her own diseases. That showed patients living in areas of deprivation improved and there were significant gains in their quality of life, and this was cost effective. The cost-effectiveness ratio was approximately £12,000 per adjusted year of life gained and this is far below the acceptable threshold in cost-effectiveness analysis used in Irish health care. It has been done abroad. It is looking at patients with multi-morbidity and multi-morbidity is where we need to look in the Irish health service.

Some 90% of patients who have diabetes have at least one other medical condition. A quarter of them have four or more other medical conditions. We cannot simplify patients into those who have heart disease, diabetes, hypertension. In essence, these patients are the same patients. They merely present with a number of conditions. This is fragmentation of the health-care service at its very best.