Alex White (Dublin South, Labour) | Oireachtas source

I thank Senator Power for raising this issue. It is good to have support and as Minister of State with responsibility for primary care, the more support I have from all sides of the House in regard to resources and the expansion and enhancement of primary care, the better. I agree with and thank the Senator for her remarks in that regard.

The national clinical programme for asthma, which commenced in 2011, is one of a number of chronic disease programmes established in the HSE's clinical care directorate aimed at bringing a systematic approach to changes in how services for patients are delivered. The national programme is included in the HSE's 2013 operational plan. Implementation of the programme is ongoing and will continue in 2014. The overarching aim of the national asthma programme is to reduce the morbidity and mortality associated with asthma in Ireland and to improve clinical outcomes and the quality of life of all patients with asthma. A key component is improved management of people with asthma in primary care, thereby avoiding emergency attendance at GP, out-of-hours services, hospital emergency departments and in-patient admission services.

In the first year of programme implementation, there was an 8% reduction in acute hospital bed days for acute asthma. The target for the national asthma programme is a further fall by 10% or more per year over the next three years, through implementing the programme's asthma guidelines and model of care. The national asthma programme is developing a national model of care for asthma, with an implementation plan which will detail how physicians, nurses, and other health care professionals will work with engaged patients to make the clinical decisions most appropriate to their circumstances and which will collaborate with specialist colleagues in providing a safe, seamless patient experience within the health system in Ireland. This is a key deliverable aspect of the national asthma programme for 2013.

As 85% of asthma is managed in primary care without the need for hospital specialist services, the national asthma programme is undertaking work to look at providing a yearly programme of assessment for asthma at primary care level. The model of care will focus on the following: "Asthma Check" outlines the step-by-step process for implementation of guideline-based asthma management in primary care, to deliver optimal outcomes for patients, with the aim being to facilitate the implementation of best practice asthma guidelines in primary care in order to improve asthma control; improving access to hospital-based specialist asthma service from primary and secondary care services, through scheduled or rapid access asthma services and access to specialist asthma therapies; improving links through clinical nurse specialists and asthma nurse specialists within the community services; developing and implementing a standard referral pathway to asthma services; developing structured assessment and review protocols throughout the system; establishing uniform discharge protocols; facilitating access to accurate asthma diagnostics; and examining solutions to develop and subsequently implement an asthma database register linked into all care levels, namely, GP, community pharmacist and hospital.

Implementation of the model of care by clinicians and managers is and will be supported by a range of documents describing care pathways, clinical guidelines and other decision-making tools. A draft model of care has been circulated to the programme's clinical advisory group for its feedback. This will be incorporated in the document and approval sought for external consultation. It is expected that the model of care will be published by the end of this year.

The programme for Government provides for the introduction of a new GMS general practitioner contract with an increased emphasis on the management of chronic conditions. It is envisaged that the new contract, when finalised, will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary primary care teams. Officials in the Department are working with the HSE with a view to drawing up and agreeing a new contract. The appropriate arrangements for chronic disease programmes will be considered as part of the new GMS contract.

The level of funding available for the health budget for 2014 has not yet been determined. The HSE is currently engaged in the estimates process. When the national clinical programme for asthma's model of care has been completed, an assessment can be made on how it will be implemented in the acute hospital and primary care system and what resources, including nursing resources, will be required.

I agree with the tenor and the direction of the Senator's observations and remarks this evening on the issue. I understand the importance of providing the kind of services and supports in primary care that she has outlined. I met with representatives of the Asthma Society of Ireland last Friday. I had a very good meeting with them, during the course of which many of these issues were raised, and I was able to give them my assurance that everything that can be done will be done in order to advance the kind of services and requirements that I believe are necessary.