Dr. Emma Curtis:

I thank Ms Hardiman. It is probably best to look at chronic disease management in two different categories. To a certain extent there is an increasing number of children with chronic and complex disease because we have got so much better at managing those conditions. Conditions might previously have led to the child's demise in early years but that no longer happens. This is due to great progress in the quality of care delivered and in medical science. There is an increase in chronic disease because children are living now with chronic disease. The emphasis now is not only on continued survival but also on improving the quality of care. This is a community and a hospital function because those children are all over Ireland and they need the support in the community such as physiotherapy, speech and language therapy and occupational therapy. That is where the national model of care comes in. It is making sure that children receive the specialist medical care they need and the community clinical care they need in order to enhance quality of life.

Another interesting part is that with the advances in understanding in genetics we can see that conditions such as diabetes, rheumatoid disorders and many of the epilepsies appear to be genetically determined. We are now understanding where the chronic conditions of a large cohort of children come from. This gives us a lever in improving treatment. These conditions are inherent to the person and therefore are not related to lifestyle or anything like that. There is a medical component. I believe that we now understand why there is an increase in the number of children with chronic and complex conditions: it is because care has improved. We do, however, have to continue to improve it. We really have to make sure we improve quality of life. Living with poor quality of life is not a huge improvement.

Obesity is a mixture - while there is a clinical medical component there is also a huge multi-agency, community and multidisciplinary aspect to obesity. Within the HSE, for example, the role of the national programmes has made a huge difference. The paediatric national programme gave us an understanding of paediatric services around the State that we really never had before. It has enabled Children's Hospital Ireland to have a national co-ordinator for this national network. The other piece that is of value from the clinical programme perspective is that it brings all of those programmes in the HSE together into a super group looking at important public health issues. Childhood obesity and well-being is one of those issues. It will involve education, facilities for sport and recreation and basic nutritional advice for every mother of a young child. It is a huge programme but it is encouraging to see that it is more of an issue now and people understand that it needs to be addressed.

We will continue to see a growth in complex and chronic health conditions, and hopefully through a multi-agency involvement we might begin to address a more complicated issue such as obesity, which is a health issue because of its consequences but the origins of which are much more complicated. That requires everybody to be involved.