I welcome the opportunity to contribute to the debate on the retinopathy screening programme for Ireland. Approximately one out of every 20 people in Ireland is affected by diabetes. Of these, some 140,000 are adults. The report to which the Minister of State referred earlier predicts that this figure is predicted to increase by a further 60,000 — or 5.6% of the population — by 2015. By 2025, the level of prevalence may have risen to 8%. This gives rise to major concerns on the part of many of those involved in dealing with what might be termed a crisis. The report also estimates that approximately 10% of health care spending is diabetes-related. This figure could increased by 25% in the next 20 years.

People with diabetes are five times more likely to require hospitalisation. If admitted to hospital, they are ten times more likely to be at risk of major medical complications than are non-diabetic patients. Diabetes has a profound impact on lifestyle, work, well-being and life expectancy. The life expectancy of those with type 1 diabetes usually decreases by 20 years, while for those with type 2 it is reduced by ten years.

Diabetes also causes significant morbidity. Studies estimate that type 2 diabetes is present for an average of seven years prior to diagnosis. Up to half the population may be showing evidence of the complications of diabetes at this stage. Diabetes gives rise to many such complications including blindness, kidney and nerve damage, the vascular complications that result from coronary heart disease, stroke and peripheral vascular disease, which is the main cause of premature death for those with diabetes.

As previous speakers indicated, diabetes is the most common cause of blindness and amputations in Ireland. Foot problems are also common among diabetic admissions to hospitals. A number of risks exist with regard to pregnancy and the chances of losing a baby or of an infant having a congenital abnormality are increased among those with diabetes.

The majority of patients, particularly those with type 2 diabetes, are used to being dealt with in a primary care setting. The developments in this regard show that if the proper environment was in place, those with type 1 diabetes could also be dealt with in such a setting and by hospital care teams.

I am pleased that work on the framework is to proceed, particularly in light of current predictions and forecasts relating to diabetes. For reasons relating to finance and the well-being of patients, the traditional model used to deal with diabetes cannot be maintained. I am glad, therefore, that a new model is being devised by the Minister and Minister of State and their Department. The delivery of integrated, responsive, long-term patient care will be provided in a multidisciplinary environment in partnership with patients. In practical terms, this will require self-management support for patients, decision support and clinical guidelines for health care professionals and changes in the way services are provided generally.

Many patients with chronic conditions such as diabetes do not require hospital admission. Such conditions can be managed in primary and community care settings. If the appropriate support is available and agreed protocols and pathways are followed, the majority of patients can be catered for. The central message is that we need to increase awareness about the risk that lifestyle and behaviours have on health. This is of particular relevance given the lifestyle choices of many people here which is adding significantly to the increase in the diagnosis of diabetes.

People are inclined to demand more services and funding when they learn about increased diagnosis of various conditions. Perhaps we should take a step back and consider the causes of the problem. The Minister has taken the correct approach to this issue. We need to be proactive and ensure members of the public are aware of the causes of diabetes, how the condition can be prevented and, in the event that it is too late, appropriate ways of dealing with it.

Diabetic retinopathy screening is not the only screening programme being rolled out by the Minister. I was pleased to learn recently that breast cancer and cervical cancer screening programmes are also to be rolled out. I am particularly pleased that the Minister is extending the diabetic retinopathy screening programme to the west. Those living in the west have been correctly critical that the region has been the last to benefit from previous programmes. I am pleased to note that funding of €750,000 has been allocated to implementing the first phase of the screening service which will be offered to all those who have diabetes. Approximately 30,000 people over the age of 12 years are registered with the programme in west Limerick and County Donegal, which includes my constituency.

The Health Service Executive is moving into the implementation phase of the roll-out of the diabetic retinopathy screening programme to the remainder of the west region based on a national framework document published in November 2008. One of the key features of the implementation phase is the development of governance and committee structures. I have been informed that this process is under way.

It has been decided recently that the primary, community and continuing care area of the HSE will assume responsibility for the governance of the implementation phase of the programme, now that the expert advisory group has completed the planning phase. The current status of the recruitment process is that job descriptions and recruitment forms for the eight agreed staff are with the relevant local health office. It is expected that these posts will be advertised shortly. This is welcome news.

While I understand no funding has been expended on equipment, I am pleased to learn funding continues to be available in 2009. The formal procurement process for the ICT requirements of the programme will, I understand, commence in the coming months. There does not appear to be alternative means of using existing resources to extend the programme. The HSE has made some progress in commencing and writing specifications for the ICT system but final decisions are awaited on the details of the implementation and governance structure before a procurement team can be formally established.

I welcome the efforts of the HSE and relevant Ministers in the diabetic retinopathy screening programme. The proactive approach taken on this issue will be welcomed by patients across the country.

See this speech in context