Liam Twomey (Fine Gael)

Given the seriousness of diabetes and the awful impact it has on patients in the Irish health care system I am disappointed by the Fianna Fáil motion tabled for the House. Apart from acknowledging there has been an increase in diabetes and we should all live healthier lifestyles, there is no effort to say what strategic policy developments there have been in recent years or what the HSE is developing and rolling out in the treatment and management of the disease.

Diabetes is a shocking disease within the Irish health care system and has a shocking impact on patients and families. As we know, prevention is better than cure but the cure needs a clear management plan and needs to be updated and changed constantly because the care of diabetes also changes constantly. If one talks about changing lifestyles, one must talk about changing the mindset of the people. I have seen patients with below the knee amputations who continue to sit outside hospitals smoking their brains out and patients with poorly controlled diabetes who come to my surgery and have no regard whatsoever for the seriousness of their disease or for their alcohol or smoking habits. There is no point in lecturing such people. It is all about lifestyle changes and changing mindsets about a disease that is increasing all the time.

Senator Feeney is right to say it is almost out of date to talk about diabetes on its own. We now speak about metabolic syndrome which takes into account obesity, blood pressure, high cholesterol and lack of exercise as well as diabetes issues. One can no longer treat diabetes as a separate disease because there are other factors such as the risks posed by high cholesterol and high blood pressure and what obesity and lack of exercise do to the human body. These factors occur with diabetes in very many cases.

When I was Fine Gael spokesperson on health and children I published a detailed screening programme that included not only diabetes but also a number of diseases prevalent in society, again related to cholesterol and blood pressure factors. That was in 2004 but nothing has happened since. Not only did the Government not manage to steal that policy, it made no effort to take on board a very simple screening policy that could have been implemented across the primary care system and that would have had a considerable impact in diagnosing diabetes in people who do not know they have it and instilling the mindset that we must have a different way of looking at these diseases.

When we worked on that policy of screening and dealing with diseases such as diabetes, it was not only what I thought that was important. There were meetings with our education spokesperson, Deputy Olwen Enright, and our sports spokesperson, Deputy Jimmy Deenihan. We recognised it would be very difficult to change the mindset of people in their 40s or even their 30s in regard to their alcohol, smoking and exercise habits. The best place to start changing public policy is in the schools and therefore the treatment of these types of diseases in our society is as much a concern for the Ministers for Education and Skills and Tourism, Culture and Sport as it is for the Minister for Health and Children. We need to get young children active and eating properly and we must open up their minds as to what causes diabetes and many other related diseases.

Clearly, the Government has done very little about prevention and most of what happens within Irish society is simply being done on an ad hoc opportunistic basis by general practitioners. There is no clear programme as regards prevention and screening for diabetes within the health care system.

As regards its management, diabetes is considered to be a chronic disease that needs proper management in a structured programme. Dr. Velma Harkins, who is based in the midlands, wrote an excellent programme as regards managing patients with diabetes within the primary care setting. I am not talking about the hospital setting where patients attend clinics once a year, but rather the management of patients in general practice within the primary care setting, with public health doctors and nurses, the practice nurses and their own GPs. That programme has gone nowhere, however. It was an excellent policy that was written up, but it is only implemented where GPs themselves are interested in diabetes. There is no focus from the HSE or drive for the programme to be given by the Department of Health and Children. All we get are more reports and fine words, but no action.

That is why diabetes continues to increase in this society as we continue not to face up to our responsibilities as regards dietary habits, weight, smoking, drinking etc. We are not getting leadership from those we might expect it from. There is a need to be honest with ourselves as regards what is being done and what should be done. However, that type of focus is not happening. I appeal to the Minister of State to go back to basics. Let us look at lifestyle, but also the mindset that changes it. Let us look at prevention, but be honest about what we are going to do in this regard. Prevention is not just about a few advertisements on television. It is also about a screening programme. Just look at BreastCheck and the cervical cancer check programme, and how they have changed the mindset among patients that these diseases exist and something needs to be done about them.

It is the same for diabetes. If there is a screening programme for high cholesterol, high blood pressure or the risk of diabetes within the population, it raises public awareness and that is how we will get action. That is what prevention being better than cure is all about. However, if we have to look after patients who are unfortunate enough to contract diabetes, let us have a proper management plan. The best place to look after those patients is in primary care. The policy is already written. The Minister of State can refer to the Irish College of General Practitioners and speak to Dr. Velma Harkins and others who will show her an excellent policy that may be easily applied right across the country to look after patients in a primary care setting. That helps to reduce the cost of diabetes to the health care system by moving it out of the hospital setting where the more serious diabetes cases can be looked after including patients suffering from complications of the cardiovascular system, renal system and virtually every system of the body.

There is a need for us to adopt that type of proactive approach in dealing with diabetes. There is an immediate cost benefit for the Government if it can get this programme right. It may have to spend €40 million or €50 million on a proper screening programme to look at all illnesses, but that would deliver a very quick return to the State. We need to get back to addressing how medicine should work, in which case we shall do much better for patients in the long-term.