Dr. Colm Henry:

I thank the Deputy for an interesting question. If we look at chronic disease management as a spectrum without picking any one illness, we will see that it runs from prevention, in the first place, and promotion, to early intervention and what we call secondary prevention, which means that if somebody has an established disease such as diabetes, we treat blood pressure and make earlier interventions before things become really serious, to the end of the spectrum, which involves serious illness, hospitalisation and even intensive care and end-of-life care. Deputy Shortall will be aware of this information because it is a theme in Sláintecare. For too long, we have invested in the right side of the spectrum, namely, in the intensive side of care, in hospitalisation and in specialist care. This is unsustainable. When we look at the profile of chronic disease in Ireland and other western countries, we can see an epidemic of chronic disease, where upwards of 70% or 80% of GP consultations are with people with chronic disease, as well as up to 40% of attendances at accident and emergency departments.

What we are trying to do with this programme is to build on what has been essentially pilot work in setting up networks of care across the roughly 96 community care networks in Ireland. We want to expand them rapidly, beyond what has been a relatively small number to date, so they can provide loops, circuits and episodes of care that do not go through acute hospitals. We want to intervene and address problems earlier, such as blood pressure, and foot problems in people with diabetes, for example, instead of having a line of defence which is very deep and at hospital level. This is, therefore, a capacity-building exercise. It is a slow game, but it is essential to invest in this aspect now so that we do not have to depend continually on hospitals to deal with that right side of the spectrum of chronic disease management, which is the intensive and resource-heavy side.