Dáil debates

Thursday, 5 June 2008

2:00 pm

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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Question 8: To ask the Minister for Health and Children the reason no action has been taken on foot of the Health Service Executive expert advisory group on diabetes report which was completed in September 2007; and if she will make a statement on the matter. [22245/08]

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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The diabetes expert advisory group was established by the Health Service Executive and presented its first report to HSE management in April 2008. The expert advisory group made a number of recommendations relating to, for example, an integrated model of care for diabetes, clinical guidelines, ICT, education and empowerment of patients, retinopathy, podiatry and paediatric services.

The expert advisory group is currently progressing recommendations related to standards and it is hoped to publish these shortly. Clinical guidelines are to be formally launched by the Minister, Deputy Harney, on 16 June 2008.

As regards other recommendations that relate to service provision, the expert advisory group is currently in discussion with the key service deliverers in primary and secondary care to progress an integrated model of care, paediatric services and retinopathy screening. The expert advisory group continues to meet on a monthly basis and localised meetings in the four areas are also being undertaken at present to raise awareness of the work of the expert advisory group.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The Minister of State has not really answered the question. The group has met and the report is completed, yet nothing is happening. Is the Minister aware that diabetic eye disease is present in up to 50% of persons with type two diabetes by the time they present for diagnosis?

Did the Minister see the "Prime Time" programme during the week which detailed how a young girl has lost one eye as a consequence of diabetes? The lack of screening of diabetes in this country — it is estimated to affect 250,000 people, 100,000 of whom do not know they have it — costs the State a fortune in terms of complications that arise because of a lack of action that would prevent complications of eye, renal and cardiac disease.

If there was ever a case for preventing an illness or detecting it early, this is it. The Minister will be aware I called for a national body test in the past but there was no mention in the programme for Government of age-appropriate annual check-ups. Nothing has happened.

Now we have another report compiled by a group of experts making recommendations but nothing has happened and it is being left on the shelf. The funding which was there previously, put up by a drug company in Beaumont to initiate an excellent outpatient operation in conjunction with GP service, was withdrawn and the State would not take it over. Will the Minister confirm when the expert advisory group's report that was completed in 2007 will be published and its recommendations implemented? I am more interested in when its recommendations will be implemented than when it will be published.

Can the Minister explain why the mobile retinopathy screening service in the north west has not been expanded, despite the fact that funding was set aside for its expansion in 2007 and 2008? I cannot let this matter pass. Additional money — €750,000 — was given this year but it still has not been used.

I wish to raise the issue of the allocation of funds for specific policy objectives that are highjacked by the HSE for its own ends. This matter is important because it is the key to how things stand and it was not addressed by the Minister earlier — it got the Taoiseach so exercised recently that he threatened to silence the Opposition. Will the Minister address this?

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Are there plans for a national diabetes screening programme?

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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We would like the retinopathy screening service in the north west to continue and our officials have contacted the HSE in this regard. We hope to see progress in the near future.

Regarding the report, the Deputy suggested nothing has happened but timing is important. He referred to September 2007 but the report went to HSE management one month ago. We are discussing what has happened in the past four weeks and we should get the timing right. HSE management is considering the report and is doing its best to implement the recommendations it contains. The clinical guidelines the Minister is to launch on 16 June, which I referred to in the reply, are of practical value for people because there has been agreement between GPs and consultants on who does what, when they do it and where. This is important for patients presenting with diabetes and the continuum of care and clinical management was covered in the agreement for the guidelines. The guidelines will be very good and may be used for other specialties because it is good that those involved know what each person will do, how it will be done and so on. This is important for some of the clients referred to.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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My understanding is that the report was completed last September. Is the Minister of State saying that is not the case or is she saying that, despite being completed last September, the HSE has only received it now? Perhaps she will correct the record of the House for me. I understood the report was completed last September.

I agree it will be an excellent model of care but "will" is an unfortunate word. When will it come into use? We have known for some time about diabetes. The issues around models of care have been tried in other countries and on a pilot basis in this country, but we are still waiting for yet another report. This is like reinventing the wheel; the knowledge exists and the outcomes have been proven. The basis for going ahead with a national programme for diabetic care under a chronic illness model is to be welcomed. When will this happen and why are funds that were put aside in specific cases not being used? As I asked the Minister earlier, what will the Government do about this situation in which its policy objectives can be usurped by the HSE? For one reason or other budgets are not spent and are used for other purposes. This is a serious question that the Minister for Health and Children, Deputy Harney, should answer.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The money is used for services, drugs, medical cards and hospital care. People are not putting the money in their pockets.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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It is clear that Government policy, as promised, is meaningless. The bureaucrats in the HSE are left to determine how health policy is enacted and that is why we are in the mess in which we find ourselves. Frankenstein's monster is out of control and its creator has walked away from it.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is ranting again.

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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The management of chronic illnesses, including diabetes, is a priority in the new contract with GPs. The clinical guidelines will be launched on 16 June.

Regarding the report's timeframe, it was not finalised in September 2007. The first report of the diabetes expert group was drafted in October 2007. On 17 December 2007 the expert group met HSE regional and sectoral representatives and decided a gap analysis report should be conducted. That report was completed on 13 February and a summary document was then created. The report did not reach HSE management until April 2008 and it has been there for the past few weeks.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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When will the report be implemented?

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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I outlined the outcome of some of the elements relating to it. The report has only been with HSE management for four weeks. It is a very good report with many good recommendations and there are suggestions relating to models and standards of care and clinical guidelines that can be implemented.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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There is no timeline.

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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I stress again that implementation of the report relating to areas that can be addressed, within the resources of the HSE, has commenced.