Patrick O'Donovan (Limerick, Fine Gael)

I thank the Members of the Technical Group for raising this issue and, in particular, Deputy Maureen O'Sullivan, for her thoughtful remarks. Two of the issues raised have struck a chord with events in my family in the past 12 months, namely, chronic obstructive pulmonary disorder, COPD, and transient ischaemic attacks, TIAs. Until then, I had not a clue what either of these were. Any family unfortunate enough to be affected by cardiovascular disease knows it is not a nice experience. I am aware the Minister speaks from personal experience on this issue and so do I. I believe that anything that can be done in a cross-party way to try and raise awareness of the issue must be welcome.

The work of the Irish Heart Foundation in this regard is welcome and I am pleased it is now proposed to have a national register. We are aware from dealing with cancer that if we can identify the at-risk categories at an earlier age and get to them then, we can spare them significant problems. Some 10,000 people get a stroke every year, but they are not the only ones affected. There are also 10,000 families affected and a potential 10,000 carers who must care for a stroke victim who, until the day before his or her stroke, was independent and could go about daily life but is now a fully fledged invalid. In many cases, two lives are affected: those who are cared for and those who care for them. Thousands of lives are affected, therefore, and not just the lives of those who suffer from cardiovascular problems, particularly stroke.

Last October I raised an issue with the Minister by way of parliamentary question concerning off-duty doctors visiting patients, particularly in rural areas and areas covered by co-op doctors. As we know, we should watch out for the early signs of stroke or heart problems. We cannot force individual doctors to carry particular instruments, but if all doctors were obliged to carry an oximeter, for example, they would be able to measure the lung capacity and the amount of oxygen in a person's lung. This might be a further yardstick for someone experiencing tiredness and weakness to let them know they are en route to a TIA, stroke or chronic heart attack.

I welcome the Minister's commitment to the community aspect of this and the commitment he has set out on rehabilitation units. We need significant capital investment in this regard. The Minister will be aware that one particular community hospital very close to my heart has taken an initiative in its local community to drive forward on this issue and is providing in excess of 20 beds for rehabilitation for people coming out of acute hospitals, such as the Mid-Western Regional Hospital. It is providing a service for people, especially those who have been discharged from hospital but who have been exposed to hospital acquired infections. These people cannot go into typical rehabilitation units because of the risk of contaminating everyone else and they therefore require single rooms . The earlier these people get their speech, occupational and physical therapy, the better the outcome for them. Therefore, it is important that we have units offering single rooms located in communities, because these are people who have been exposed to hospital acquired infections and who cannot leave the acute hospital until the infection has cleared. They are stuck in a rut waiting for the infection to clear up but are liable all the time to get another infection. They are deprived of the opportunity to avail of the rehabilitation and therapy they need to get their lives back on track. The sooner they get that treatment, the sooner they get back to some level of normality, and the sooner their families are able to pick up the pieces.

The option of pharmacy-led COPD clinics is being considered in the United Kingdom. Many people would not be aware of COPD, which is a long-term lung disease which means a person's lungs begin to wind down, thanks mainly to smoking. If people want to see what smoking does to a person, they should visit any one of the rehabilitation units throughout the country where they will see older people who smoked all their lives. During the war, they may have smoked turf dust rolled up in newspaper because they were so badly addicted to smoking. One will see in those units at first hand what smoking does to a person's life.

I am glad the Minister mentioned the issue of obesity, which is an issue I have raised with him. The sooner we have a national obesity advocate who will drive forward change in this area, in the same way Gay Byrne was able to drive forward change in the mindset and culture of the people from the road safety point of view, the better. That advocate can instil the knowledge that what people ingest will have a long-term impact on their lives. There is no doubt about that. Currently, some 25% of all three year olds in the country are overweight and this will manifest itself as a massive problem in the future. The Minister can put aside all the billions he wants, but type 2 diabetes and obesity related illnesses, whether cancer, stroke, heart attack or whatever, cost €6 billion currently. This is easy to quantify in terms of the impact of this on the HSE budget. However, we cannot quantify the social damage being caused by these illnesses.

We need to arrive at a position where people realise the effect of these illnesses and of what they ingest or inhale, whether alcohol, food or cigarette smoke. We need to get to a position where we have national advocates who can describe in basic language for people the effects of the culture of bad habits in this regard. We need a cohort of people who are respected, such as a sports person like Eamonn Coghlan, and who are regarded as experts in their field who can speak on these issues. This is essential. Otherwise, we will wind up in a situation where we will continue to have these discussions.

Obesity is not just an issue that will affect the Minister and the Department of Health. It is a multidepartmental issue. It will affect education, agriculture, transport, the environment, the arts, finance and a clatter of local authorities and State agencies. These groups must be brought together under one umbrella with the sole motive to reduce the overall weight of the people. If we do not do that now, the problem will become so big that we will not be able to take control of it. Type 2 diabetes is a killer. It is a life-changing illness, along with stroke. The damage it does, not only to the individual who becomes an invalid, but to his or her family and the wider community, cannot be quantified nor can it be estimated in billions of euro.

I implore the Minister to do whatever he can in his tenure to take these issues on head-first, and he will be doing future generations a significant service by doing so.

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