Liam Twomey (Fine Gael)

I congratulate the Minister of State, Deputy Brady on her appointment. She has a difficult task ahead but that is the job of Ministers.

If we look at the Government's response to diabetes and the issue of the diabetes crisis in our health care system during the good times in this country, I have very little confidence we can really deal with this crisis when money is in short supply for the HSE. Too much of what was said here today concerned what the HSE is doing. It is quickly becoming a discredited organisation in giving direction to deal with this sort of crisis. For us to have statements in the Seanad on the framework for the development of a diabetic retinopathy screening programme shows we are somewhat out of touch with what is happening on the ground. We have enough framework documents to keep us going for another decade. We are, to some degree, putting the cart before the horse.

It is amazing that we have only two primary screening programmes in this country, those for cervical and breast cancer. If one considers all the diseases and illnesses in the health care system which can be effectively screened, it is amazing we do not have primary screening for any other disease on a nationwide, and not a partial. It concerns not just diabetes, but cholesterol, blood pressure and bowel and prostate cancer. All of these can potentially be screened for before they become a problem.

The Government is letting people go blind by setting up another committee and looking into another framework document because this disease affects the poor disproportionately. Believe it or not, a person is not covered by the medical card system, which an ordinary person uses if they cannot afford primary care, to get their cholesterol or glucose checks as a screening for diabetes. In other words, the medical card system does not cover patients to get adequately screened for common diseases. What confidence can one have that a Government which cannot manage to cover a basic screening programme on a medical card will implement a more complex programme such as a retinopathy screening programme for diabetes?

It is fine to talk about personal experiences regarding diabetes, but I deal with this on a more practical level, in the sense that I still look after patients in general practice. I cannot get access to a dietician. I have to push for ophthalmology, even though we know it is incredibly important, not for screening but to make sure patients do not go blind before they show signs of it. It is very difficult to get them screened.

We were recently approached by the hospital where I see patients and were told it can see new patients but will have to cut back on seeing existing patients, as it cannot do both. In other words, we are now playing King Solomon with patients. Do we get new patients with diabetes seen or adequately look after the patients who have diabetes through the current hospital system? There is no engagement between the HSE and primary care, the GPs, on how we could effectively move programmes from the hospital into the general practice setting. We might talk about it, have nice documents about it and have policies on it but it does not exist.

It reminds me of when Hitler was moving tank divisions around the eastern front, when such divisions never existed. It is fine to talk about these things but we are not doing them. We are not even touching on them in terms of the practicality of how we run our health services.

If we are serious about this, let us have a proper screening programme which looks generally at how we can screen patients effectively and cheaply across the country. We are not screening for very simple things. The number of patients who are getting strokes and heart attacks because of high blood pressure is ridiculous. The number who are getting diabetes, and the complications of it, is ridiculous when one considers that a simple blood test would diagnose the 140,000 people who are walking around with undiagnosed diabetes. One simple blood test, carried out by a doctor or nurse, would sort out that problem, yet it is not happening.

We seem to have a habit in this country of wanting to screen for diseases after we know they exist. We are talking about screening for diabetic retinopathy when we already know the patient has diabetes. The only other such screening programme in the Irish health care system is the heart watch programme, which screens patients for heart attacks after they have had a heart attack. We try to prevent heart attacks in patients, but they must first have a heart attack to become part of that screening programme. That is how daft the running of our screening programmes in our health service is currently.

When one is talking about prevention, there is another major issue coming down the line in this country, that of metabolic syndrome. I remember mentioning this to the Minister for Health and Children, Deputy Mary Harney, and she gave me some waffle about a framework document and the setting up of a policy group. Metabolic syndrome is becoming far more important than diabetes because it covers the issues of obesity, diabetes, high cholesterol and high blood pressure within the patient population. It is causing strokes, heart attacks, diabetic ulcers, kidney disease, liver disease and blood vessel disease and yet nothing is happening. We are spending billions of euro every year on these diseases.

The Minister of State is talking about a retinopathy screening programme which she cannot guarantee will have the proper person taking the photographs. It was stated an optometrist will take the photograph if possible. Who will take the photograph if the optometrist does not? I certainly would not like anybody to take a picture of the back of my eye, unless they were trained to do so. It is ridiculous that this is the best that has been come up with, on the theoretical basis of a screening programme. We should go back to basics, to the simple things we can do to prevent such diseases. Simple blood tests can prevent many of the diseases we are talking about. Screening programmes can be carried out in the context of primary care. If we consider what is happening in terms of diabetic care in hospitals, we will see what a mess it is in. If we sort out these issues, we can then start looking at top-notch medicine. Some of the things I hear from Government put me in mind of buying a car with an anti-lock braking system, ABS, and the best CD player but forgetting about the doors. Let us get practical in terms of what we can achieve in our health services.