Jan O'Sullivan (Limerick East, Labour)

I would like to share my time with Deputy O'Shea. I hope this debate will do what the Irish Endocrine Society and the Diabetes Federation of Ireland hoped, namely put pressure on the Government and HSE to ensure the programme for diabetic retinopathy is rolled out in the recommended timeframe and the various recommendations of the expert advisory group are implemented. It is a disgrace that these recommendations have not been implemented in any way.

Like Deputy Reilly I was at the meeting of the health committee and he has quoted extensively from the presentation. Everybody on the committee was very struck by the urgency of this issue and the cost-effectiveness of the recommendations. Approximately 15% of acute beds are diabetes related and 10% of the budget is in some way related to diabetes. As Deputy Reilly said, the roll-out of the diabetic retinopathy programme would be cost-effective if one sets the cost of the screening programme and the treatment that would arise against the cost of people who have become blind as a direct result of diabetes. In the medium term money would be saved.

I would like to focus on the Minister of State's reply and what she might tell us in it. I found her initial contribution very disappointing because most of it was spent in describing the problem and only the last half page or so was on what is going to be done about it. I welcome that it is intended that this €750,000 that was meant to be spent last year will be spent this year and I hope the Minister of State will give us a categorical guarantee that it will happen this year and the roll-out in the north west will go ahead. As Deputy Reilly said, it is relatively small money. The health service is in financial crisis and there will be cutbacks everywhere, and we will debate that next week. However I urge the Minister of State that this relatively small amount of money, which has the potential to save money in the long term, be ring-fenced for this purpose. I refer not only to this year's money for the north west but the money required to roll out the programme for the rest of the country over four years.

We all have experience of money being set aside for such programmes as A Vision for Change and the hospice movement in the development area of the health services, and that money has gone into black holes and been spent in other areas. I would like a guarantee from the Minister of State that there is a commitment from Government that this money will be ring-fenced. Representatives of the HSE at the health committee told us that while they did not ring-fence funding for mental health and other areas up to last year, they had found a mechanism for ring-fencing it in the future. If they can do that in other areas they can do it for this programme also. I urge the Minister of State to give us that commitment in her reply.

There is a real concern among those who represent the diabetes community and those who care for people diabetes that the north-west service will be put in place this year but somehow or other the rest of this roll-out will be left behind. These programmes are vital for people who have diabetes or who may develop diabetes because they literally prevent blindness. It is a relatively simple procedure, as Deputy Reilly and the Minister of State, Deputy Wallace, outlined.

This programme dates back to the St. Vincent's declaration 20 years ago, and the diabetes service development group set up in April 2001 where the health care professionals came together because there was no Government action. Following on that, there was a Department of Health and Children working group and there was the expert advisory report published in November 2008. Then there was the commitment to spend the money, yet we still have not seen any action. It is vital that we make progress on this element of the prevention of complications of diabetes which is doable.

I want to refer briefly to the issue of podiatry and chiropody because that is also a serious problem for people who suffer from diabetes. Somebody who came to my clinic recently is a diabetic — who has a medical card and is on disability benefit — had been getting chiropody treatment on a monthly basis. He has had a toe amputation and needs this chiropody service but he was told that because he is not over 65 that service will discontinue. I tabled a parliamentary question to find out if this is the case throughout the country. Apparently, priority in the community chiropody service is given to the over 65s and people under 65 may get it at the discretion of the service if the funding is available, but it looks as if in these difficult times that funding is being cut as well. I want to make that case while I have the opportunity. These are clearly people who for medical reasons need this service and who do not have the ability to pay for it. It is an example of many of the cutbacks impacting on people. Individuals know it is happening to them but they, and at times we, do not know that it is happening throughout the country. I would urge that this matter be examined and that people who genuinely need these services are given them as they need them.

It is clear that the retinopathy screening programme involves a saving. According to the figures, as Deputy Reilly stated and as given to us at the committee, diabetes is the commonest cause of blindness in working age adults. Approximately 5% to 10% of people with diabetes have sight-threatening retinopathy which requires expert ophthalmic follow-up treatment. Using this figure it is anticipated that 14,000 to 16,000 people will develop sight-threatening retinopathy by 2010. This is a sizeable section of the population.

I again urge that today's debate be a positive measure in moving forward to ensure this programme is put in place and that it is rolled out over the next four years to the entire country.

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