Mary Ann O'Brien (Independent) | Oireachtas source

I move:

“That Seanad Éireann:

notes The Case for Change report published by the Asthma Society of Ireland in February 2014, which included commentary on the prevalence and seriousness of asthma in Ireland; and

acknowledges that:- there are very significant numbers of people in Ireland living with asthma;

- hospital admissions from asthma are considered avoidable; recent OECD statistics show that the rate of admission in Ireland is slightly below the OECD average;

- through a combination of the means-tested medical and GP card schemes and the phased roll-out of universal GP care, more people than ever before (over 2.1 million people) have access to a GP service without fees, including those families facing undue financial burdens and the youngest and oldest in society;

- medical card holders are entitled to prescription medicines free of charge, subject to prescription charges capped at €25 per month per person or family;

- under the drugs payment scheme, no individual or family pays more than €144 per month towards the cost of approved prescribed medicines, which significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines;

- significant progress has been made by the HSE in the development of the national clinical programme for asthma:

- the programme has focused on the development of national asthma guidelines based on international best practice, both for acute care and ongoing asthma management;

- emergency asthma guidelines for adults and emergency paediatric asthma guidelines have been published;

- the emergency asthma guidelines for adults are currently being considered by the national clinical effectiveness committee and, once approved, will be formally launched;

- guidelines for managing a patient with asthma in primary care have been approved by the Irish College of General Practitioners and were launched in May 2013;

- the model of care for asthma has been approved by the HSE and is due to be launched in the coming months. The model of care details how physicians, nurses, and other health care professionals will work with engaged patients to make the most appropriate clinical decisions and to collaborate with specialist colleagues in providing a safe, seamless patient experience within the health system in Ireland;

- easily accessible patient asthma education supports have been developed in conjunction with the Asthma Society of Ireland to assist guided self-management;

- the community-based asthma integrated care demonstrator project is scheduled to commence by the end of 2015; and

- proposals for an audit of asthma deaths are being developed and will be expedited;

- on 1st July 2015, GP care without fees at the point of access was introduced for children under six years, providing an enhanced service that includes an agreed cycle of care for children diagnosed with asthma;

- negotiations are under way on a comprehensive new GP contract, a priority of which is the inclusion of chronic disease management, including asthma; and

- the Government is committed to the extension of free GP services to all children under 12 years of age, subject to negotiations in relation to the scope of the service to be provided and the fee arrangements to apply.”

I welcome the Minister of State. I also welcome Sharon Cosgrove, chief executive officer of the Asthma Society of Ireland. The two asthma sufferers with her are a little like Coca-Cola; they are the real thing. They are Rebecca Fitzsimons and Catriona Kennedy. I welcome them and thank them for coming to the Gallery this evening.

We are here to discuss asthma, which, believe it or not, directly affects 470,000 people in Ireland. When I was approached by the Asthma Society of Ireland to table this motion, I quickly discovered that I had little knowledge of the prevalence of asthma in Ireland and the debilitating effect it can have on those with the condition.

What is asthma? Asthma is a condition that affects the airways, the small tubes that carry air in and out of the lungs. The airways become oversensitive which means they react to things that would normally not cause a problem, such as cold air or dust. This reaction causes muscles within the wall of the airways to tighten and become narrow, thereby making difficult for the air to flow in and out. The lining of the airways becomes swollen and sticky mucus is produced clogging up the breathing passage. I have talked to some sufferers in preparation for this evening. It is difficult for us to imagine. It is somewhat like breathing through a tiny straw and being absolutely terrified while the chest is hurting at the same time. It feels like one is fighting for one's life.

I wish to read some statistics into the record this afternoon in order to help us to keep our conversation in perspective. Ireland has the fourth highest prevalence of asthma in the world. In itself, the reason for that deserves to be a research project. One adult in ten has asthma while one child in five has the condition. Some 60% of people in Ireland have uncontrolled asthma, meaning they are at risk of an asthma attack. Every 26 minutes someone visits an accident and emergency unit because of asthma. More than one person every week dies in Ireland from asthma, although 90% of asthma deaths are preventable. The economic burden of asthma is estimated to be €500 million per year. Adults miss an average of 12 days of work each year due to asthma and children miss an average of ten days in school due to asthma. On average, asthma patients spend €150 per month on medication and they can spend up to €450 per year on general practitioner visits.

The information I have set out is rather stark. My motivation in tabling the motion - and that of the Asthma Society of Ireland in encouraging me to do so - is to draw attention to the serious challenges that asthma presents to us as policy makers. More importantly, it highlights the effects and burden that asthma places on those unlucky enough to have the disease.

The Asthma Society of Ireland was keen for me to acknowledge the Minister of State's positive engagement with it since she took up her position in the Department of Health. In particular, the society referenced her most recent meeting with its representatives prior to the introduction of the budget in October.

We should reference the inclusion of the asthma cycle of care in the general practitioner contract relating to those under six years of age and the intention of the Minister of State to include that in the finalised contract relating to under 12s. Furthermore, we should reference that the HSE is looking favourably on, and is engaged with, a proposal to fund the Asthma Society of Ireland asthma advice line next year for the first time. This is a vital free resource for those with asthma in Ireland. I hope the talks will conclude positively in the coming weeks. I welcome the recent announcement by the Minister of State that the society would receive €45,000 in nationally lottery moneys to help fund the inhaler technique campaign which the society ran earlier this year throughout the country. However, despite these positive actions and the signs of future actions, many grave problems still exist for people in Ireland who are living with asthma. I will outline some of these for the consideration and response of the Minister of State. I know my colleague, Senator Power, will have a unique perspective on this topic as, unfortunately, she is asthmatic. As with most situations in life, those who have walked in the shoes have the best understanding of the problems and challenges encountered on a daily basis.

As the Minister of State will appreciate from the time she has spent in the Department of Health and in politics in general, most of the time people clamour to highlight problems but few come to the table with suggested solutions. I am not for a moment suggesting that this is what I am doing; I am merely going to point the House in the direction of the HSE national clinical programme for asthma, NCPA, which was agreed in 2011 following extensive consultation with all stakeholders. Much to the frustration of the asthma society and its members, implementation has been slow, at best. I note that the NCPA has developed a large range of guidelines. However, I imagine even the Minister of State would acknowledge that implementation of the programme has not been seen, in particular, in primary care settings. While this programme was developed before the period of the Minister of State in office, I am keen for her thoughts on why full implementation has been so slow. I find it somewhat puzzling given that the HSE signed off on the plan. Why has delivery been so difficult? Has the Minister of State encountered opposition from the medical bodies or has the issue become lost in the broader health reform programme?

In its simplest form, the NCPA means that everyone with asthma in Ireland can avail of structured best-practice asthma care in their community. Having read up on the programme it seems to me to draw on international best practice and learnings. For the want of a better description, it presents the motorway to transforming the experiences of people with asthma in Ireland. Interestingly, it should result in financial savings for the health service. I call on the Minister of State to set out the achievements to date with the NCPA and outline her vision for its implementation in the period ahead. I know the asthma society and those gathered in the Gallery are keen for the Minister of State to share her opinions on the following potential actions: the introduction of a scheme to assist people with asthma with the financial burden of their disease - a point Senator Power will illustrate in few moments; the delivery of a free annual asthma review for each person with asthma, as recommended in the HSE national clinical programme for asthma - this is crucial for a good asthma management; and, as per the national clinical programme for asthma, the undertaking of an asthma deaths study nationwide. As a country, this is something we must address as soon as possible. I await the contribution of the Minister of State with interest.