Seanad debates

Thursday, 23 April 2009

Diabetic Retinopathy Screening Programme: Statements

 

11:00 am

Photo of Paddy BurkePaddy Burke (Fine Gael)
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I welcome the Minister of State at the Department of Health and Children, Deputy Áine Brady, to the House and wish her the very best of luck in her new portfolio.

12:00 pm

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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I thank the Leas-Chathaoirleach and Members for their welcome and welcome this opportunity on my first day in office as Minister of State to speak to the Seanad on the subject of the framework for the development of a diabetic retinopathy screening programme for Ireland, which was published in November 2008.

Diabetes mellitus is a chronic, progressive metabolic disease. There are two types. Type 1 or insulin dependent diabetes accounts for approximately 10% of cases. It affects mainly children, adolescents and young adults and requires lifelong treatment with insulin. Type 2 or non-insulin dependent diabetes accounts for 90% of all cases diagnosed in Ireland and it affects mainly middle aged and older people. Its prevalence is rising rapidly due to a number of factors, including the aging population and lifestyle factors such as obesity. Diabetes is a common condition. A report, Making Diabetes Count — What Does the Future Hold?, published by the Institute of Public Health, provides the best available estimates of the prevalence of diabetes, both diagnosed and undiagnosed, in the Republic of Ireland. Just over 140,000 adults in the Republic are estimated to have diabetes -type 1 and 2 combined. The report predicts this figure will rise to at least 194,000 or 5.6% of the population by 2015, a 37% increase. It further estimates that this increase will be largely due to an increase in the incidence of type 2 diabetes, owing to the increase in childhood and adolescent obesity.

My Department's policy on diabetes, Diabetes: Prevention and A Model for Patient Care, was published in 2006. This set out a model of care based on shared care between primary care and acute services which would deliver quality diabetes care at the appropriate level. It also identified retinopathy screening for eye disease as well as patient education and empowerment, and the development of podiatry services as key areas for further development.

The Health Service Executive established an expert advisory group under Dr. Colm Costigan to take forward and implement the policy recommendations. The group published its report on 14 November 2008. The report is a blueprint for the development of services for patients with diabetes over the coming years. It is practical and patient focused, with strong emphasis on prevention, service integration and community based management, supported by specialist services. The group emphasises that real savings could be achieved in health care costs by preventing the complications of diabetes such as eye disease, specifically diabetic retinopathy, kidney disease and cardiovascular disease.

Retinopathy was identified as one of the most common serious complications of diabetes. Diabetic retinopathy is a disease of small blood vessels of the retina and is the most common cause of blindness in people aged 60 to 65. Approximately 5% to 10% of people with diabetes have a sight threatening retinopathy which requires ophthalmic follow-up and treatment. Of the estimated 140,000 people with diabetes in Ireland, approximately 14,000 will develop a sight threatening retinopathy. Screening, followed by treatment of retinopathy, is very effective in preventing blindness. International evidence shows that in a population of those screened and treated, 6% are prevented from going blind within a year and that this rate rises to 34% within ten years. Among the group's key recommendations was the introduction of a diabetic retinopathy screening programme to prevent eye disease. The expert advisory group formed a sub-group, the diabetic retinopathy screening sub-committee, to develop a framework for the development, implementation and monitoring of a national diabetic retinopathy screening programme which we are discussing in the House today.

In December 2007, and in advance of its report, the advisory group made interim recommendations to the HSE leadership team for the development of diabetic services. It prioritised the roll-out of the national diabetic retinopathy screening programme. It recommended the following targets: that funding for the development of a national diabetic retinopathy screening programme be prioritised; that funding be made available incrementally over the next four years to implement the programme in each of the four HSE areas, commencing the programme in a new area each year; that the HSE immediately prioritise funding and commence procurement for an eye specific IT system to support a national diabetic retinopathy screening programme; that the HSE set up a formal governance structure for a national diabetic retinopathy screening programme; that 95% of registered people with diabetes be invited for screening by year five of full national implementation, and that 70% of registered people with diabetes attend screening by year five of full national implementation.

In November 2008 the diabetic retinopathy screening sub-committee produced a national framework for diabetic retinopathy screening in Ireland. This framework set out the aims and principles which should underpin the development of a screening programme. The aims of a national diabetic retinopathy screening programme are to detect sight threatening diabetic retinopathy which is treatable, detect any diabetic retinopathy that it is possible to detect with digital retinal photography, provide screening on a call/recall basis according to best practice guidelines and refer patients in a timely way for ophthalmic assessment and treatment as required.

The following principles of the national diabetic retinopathy screening programme have been adopted by the HSE diabetes expert advisory group. It should be a population based call-recall programme, delivered on an annual basis. Eligible patients should include all those with diagnosed diabetes, aged 12 years and over and medically fit to attend. It will be accessible to all eligible patients, by which I mean it will be free, wheelchair accessible, delivered locally, and that provision will be made for the screening of prisoners and persons in nursing and residential homes who are fit to receive treatment. Screening should be carried out using digital retinal photography. Screening should be delivered in four area programmes, based on a population of approximately 1 million and a geographic area corresponding to each HSE area. A register of people with diagnosed diabetes should be established for each area, and collated nationally. A grading service should be developed on the basis of each HSE area population. These centres will grade images taken by all photographers in the programme for that area. The screening model should be mixed, that is, it will feature a combination of fixed and mobile clinics and, possibly, photography by optometrists depending on the geographical distribution of the population, public transport links and economies of scale. HSE areas should propose their preferred service model to the national screening committee or national executive office for approval. Screening should be carried out in cooperation with general practitioners, hospital diabetes service staff, optometrists, ophthalmic physicians and surgeons. There should be timely referral, assessment and treatment of abnormalities discovered. There should be timely feedback to the screening programme of the result of screening events and of referrals. There should be a robust system of clinical governance and quality assurance.

It was decided to continue the roll-out of the programme across the Health Service Executive, western region, as a population-based screening programme had previously been established in the former North Western Health Board. The funding was, therefore, made available to the HSE western region primary community and continuing care budget. This would allow for screening services to be offered to all people with diabetes — approximately 30,000 people over the age of 12 years — registered with the programme between west Limerick and north Donegal.

Owing to resource constraints, the diabetic retinopathy screening programme did not commence in 2008. At present the HSE is moving into the implementation phase for the roll-out of the screening programme to the rest of the western region based on the national framework document. Funding of €750,000 is available in 2009 for this purpose. One of the key parts of the implementation phase is the development of the governance and committee structures and this process is under way. Job descriptions and recruitment forms for the eight agreed staff are with the relevant local health offices. Currently all recruitment activity and recruitment competitions are placed on immediate hold pending further clarification regarding the filling of posts. Should approval be granted to fill the posts, it will then be possible to proceed to the various stages required for recruitment. The formal procurement process for the information and communications technology requirements of the programme is to commence in the coming months.

A quality assured diabetic retinopathy programme of highest international standard is being rolled out this year in the west. We hope to continue the roll-out of the programme in other areas as resources permit.

Photo of Frances FitzgeraldFrances Fitzgerald (Fine Gael)
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I congratulate the Minister of State on her appointment and wish her success. I note, however, that in the appointment of Ministers of State, she is the only woman and we have lost two female Ministers of State. I regret the number of women in the Government has taken a backward rather than a forward step, given our very low representation in the Houses generally. That is a backward step, but I wish the Minister of State success.

The key point in the Minister of State's speech was contained in its closing paragraphs, namely, that "Owing to resource constraints, the diabetic retinopathy screening programme did not commence in 2008". Another key sentence in her speech was that, "Currently all recruitment actviity and recruitment competitions are placed on immediate hold pending further clarification regarding the filling of posts." Therefore, as the Minister of State said, there is a great uncertainty about the future of this vital service.

The statistics on the incidence of diabetes in Ireland are frightening, as I am sure the Minister of State will agree. Diabetes is no longer a future threat to the health of our people, rather it is a current crisis. An estimated 250,000 people have diabetes. It is estimated that approximately 100,000 people do not yet know that they have the condition. The Minister of State might comment on this figure or report back to the House on it. A significant number of people who have the condition are undiagnosed, they do not present for treatment because they are not aware they have the condition and, therefore, they are not able to take the kind of preventative action that is necessary.

It is also expected that the number of people suffering from diabetes in Ireland will double in the next decade. This is undoubtedly an extraordinarily serious public health policy issue because the implications for people with the condition without treatment are serious. We definitely need a national debate on this illness. To tackle this public health crisis we need greater awareness, more services and more preventative work.

It is regrettable there is not a greater focus on preventative medicine and health promotion. At a time of scarce resources in particular, as well as at other times, it is important that health promotion is given a high priority. The figures for the incidence of obesity among children are startling. The increase in the incidence of obesity is also startling, it being one of the predisposing factors for diabetes. Preventative action and working with parents, teachers in schools, general practitioners and people in any centres where young people gather to try to influence young people's attitudes towards a healthy lifestyle and healthy eating is critical. I again call for the implementation of the expert report on obesity because we must examine the taking of preventative action in this area. That is critical.

Approximately 5% to 10% of all people with diabetes will develop sight-threatening retinopathy. It is a major cause for concern that up to 50% of persons with type 2 diabetes have retinopathy at the time of diagnosis. This highlights the delay in diagnosis of diabetes at an early stage.

As the Minister of State will be aware, when money was allocated to extend the mobile screening service in the north west, it could not be delivered at that time because of the recruitment ban. She might update the House in that respect. That may be the matter to which she was referring towards the end of her contribution.

I note that in the programme for Government neither Government parties considered that a national diabetes strategy merited a mention. This issue needs to go higher up the priority ladder in terms of our public health policy. There has been some apathy and a lack of urgency in addressing this serious public health issue. I welcome that the Leader placed this matter on the Order Paper for debate today. I hope we can create greater awareness about this illness.

We have the expert group report on this illness. I understand it is working on an ongoing basis. The Minister of State might clarify that. I thank its members for their work. The role of such expert groups is important in pointing the way. What is happening in terms of the implementation of the report's recommendations? The Minister of State might give Members more detail on their actual implementation. We know what the recommendations of the report from the diabetes expert group published last November indicate. They state that real savings can be achieved in health care costs by preventing the complications of diabetes, that patient education is very important — a point I have repeated — patient education and community empowerment are critical, linked to GP care and specialist care, and that a regional model of care is recommended for children and adolescents with diabetes. It also recommends a framework for a national diabetic retinopathy screening programme for Ireland which is clearly essential. It is sad to think of people who have lost their sight who, with proper treatment, early diagnosis and intervention, would not have done so.

Will the Minister of State, when replying, outline the plans for the full roll-out of the diabetes screening programme, as recommended by the expert advisory group? If the necessary public funds for the programme are not available, which is what the Minister of State appears to be saying, are there any other plans or is she considering other methods of delivery such as public private partnerships to deliver the screening programme? The shortage of ophthalmologists is an issue in rolling out this programme. Are there plans to train and upgrade the training of this group of people to ensure the incidence of retinopathy can be identified? What is the future role of the expert group?

The issue of screening makes complete sense. It will save the State and the health system money and it will also save people's sight. I saw in some research material on diabetes that the cost of the illness to the State is €350 million. I also saw figures for the cost to the State of people who are being treated for conditions such as foot ulcers as a result of diabetes. The cost in this instance is high. It can cost up to €40,000 per person for people who need inpatient treatment. This illness can have extraordinary implications. A recent "Prime Time" programme covered the case of a very young woman who lost the sight of one eye because of a lack of treatment and screening. What is the plan for the implementation of the expert group's report? A renewed sense of urgency and priority needs to be attached to the issue of diabetes and its screening. Prevention and early diagnosis needs to be emphasised if we are to minimise the serious effects of this illness and maximise the chances of successful treatment and containment.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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I wish to share my time with Senator Walsh, by agreement.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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Is that agreed? Agreed.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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I welcome our new Minister of State, Deputy Brady, and congratulate her on her appointment. Senators on this side of the House are delighted that she was recognised and promoted because she is ideally suited for her brief. As a young, modern woman with a healthy family, her eyes will be firmly fixed on health promotion.

I am grateful for the opportunity to speak about diabetes. The last occasion on which the Seanad debated this issue was in 2005. Judging from the Minister of State's contribution, it appears we have achieved 100% of the goals we set in that debate. Diabetes is a chronic progressive disease. Type 1 diabetes is insulin dependent and affects children, adolescents and adults. People who have type 1 diabetes know about it because their survival depends on regular injections of insulin. However, I am told that people can have type 2 diabetes without being aware of the condition. During our 2005 debate, the late Senator Kate Walsh, who had diabetes, asked how one could have diabetes without knowing about it. She advised anyone who noticed the signs of diabetes to seek medical advice because it is manageable if diagnosed on time.

Lifestyle and diet play a significant role in the onset of diabetes, which appears to affect older men especially. Even something as simple as feeling thirsty can be a sign its onset. As we are living longer, the current combined figure of 140,000 for types 1 and 2 sufferers will increase by as much as 37%.

In 2006, the Department of Health and Children issued a report on diabetes prevention and patient care. An expert group set up by the Health Service Executive, HSE, under the guidance of Dr. Colm Costigan subsequently issued its own report. These reports offer an opportunity for significant progress on dealing with the disease.

A "Prime Time" episode broadcast last year made for horrific viewing in its description of a secondary school student in Donegal who suffered from type 1 diabetes. This young girl's plight was raised on the Order of Business in the Seanad. Senator Fitzgerald stated that the girl went blind in one eye but my recollection of the matter is that both of her eyes were affected. It was devastating for her to be struck down at such a young age. No amount of money should be spared in setting up a screening programme to prevent such cruel afflictions because prevention is better than cure. It is also important that people are educated about the signs of diabetes.

As people tend to say the same things in debates such as this one, I will simply welcome all that the Minister of State has said rather than address her proposals in detail. Senators who were involved in our previous debate on diabetes will agree this screening programme represents an improvement on our approach to the issue. I am glad the programme has been rolled out in the west in light of that region's high incidence of diabetes. However, it is crucial the programme is adequately funded. We are all aware of the ban on recruitment and that money is short supply but I cannot emphasise enough the importance of this programme. Over a five-year period, screening will be rolled out to the entire country.

I was heartened to hear that the UK model of clinical governance and quality assurance will also apply here. During the previous Seanad, the Joint Committee on Health and Children heard from an expert group which discussed the this model. I am confident the Minister of State has the enthusiasm to keep on top of her brief. She can change the lives of many people for the better by ensuring the effective roll-out of the screening programme. I urge her not to allow the ban on recruitment to become an obstacle to spending the money available to her as efficiently as possible to help those who are struck down by this disease.

Photo of Jim WalshJim Walsh (Fianna Fail)
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I thank Senator Feeney for sharing her time with me and join her in congratulating the Minister of State on her promotion, which is a distinct honour. I have known the Minister of State for many years and am sure she will excel in her new position because she has the commitment necessary to meet her new responsibilities. She will have the goodwill of everyone in this House in that regard.

I welcome much of what she has said in her contribution. Senator Fitzgerald correctly pointed out that lifestyle is a significant factor in the onset of this pervasive disease. Our emphasis should be on education, therefore. Health promotion should include avoidance of areas that lead to diabetes, particularly obesity and the consumption of many sugar-based foods and carbohydrates. I was not conscious of the effect carbohydrates have in transferring to glucose within the digestive system, as a consequence of which they can lead to high blood sugar levels. I am sure Senator Twomey will be able to correct me if I am wrong, but if I sound knowledgeable about this it is because 18 months ago I had a dry mouth, a condition to which Senator Feeney referred. I went to have it checked and the GP subsequently rang me to say my sugar levels were borderline and near the danger zone for diabetes. I said it was not too bad if it was borderline, but asked what the limit was. The doctor's reply stuck with me because he said having diabetes was a bit like being pregnant, that one cannot be a little bit pregnant — one either has it or not. He sent me to a dietician and in the meantime I checked in a DIY book I have at home, which is a medical encyclopaedia, to compare diabetes types 1 and 2. I was surprised that there are no life expectancy issues with type 1 diabetes, providing a person takes insulin. However, with type 2 diabetes there is a life expectancy issue because of the progressive nature of the disease, so that motivated me and having gone to the dietician I decided to apply the advice. I lost two stone and went back to the GP about six months later to get a baseline, which should have been done much earlier. He rang me subsequently to say there was good news: I was not suffering from diabetes and my sugar levels were half what they were before. It means however that I could well be a candidate for diabetes but hopefully by catching it in time and dealing with it, one can avoid it.

That brings me to the point because the Minister of State laid heavy emphasis in her speech on the measures that are being taken for diabetic retinopathy screening. That is absolutely essential because loss of eyesight is a terrible affliction and disability. People who suffer from diabetes are in the high risk category so we should place the emphasis on investing in such a screening programme.

As Senator Fitzgerald said, there are many people with undiagnosed diabetes and others who may well develop it within the next few years due to their diet and lifestyle. While the emphasis on screening is for registered diabetics, there should be an educational programme aimed at those with undiagnosed diabetes and others at risk. Perhaps the screening could be extended to such people so they can be checked in time. In many ways, investment in this type of diagnostic area can save a lot of money in the health service later on. Apart from loss of vision, the Minister of State mentioned other factors including kidney, liver and cardiovascular disease which is common. The cost of treating those diseases, if diabetes develops, is extremely high and therefore I advocate educating people so they are aware of the problem. In addition, screening should be provided for early detection and hopefully people will be motivated to make the necessary lifestyle changes to avoid the potential effects of diabetes. My comments are based on my experience and the limited knowledge I accumulated from it. One of the changes I made was to use the stairs rather than the lift, as my office is on the third floor. A former Minister for Health, Deputy Rory O'Hanlon, told me that when he moved into the Department he stopped using the lift and has never used it since, although he is now on the fifth floor. Once we become aware of the dangers and risks involved, small changes like that can make a difference. I am sure Senator Twomey's contribution will be much more expert than mine, given my limited medical knowledge.

I encourage the Minister of State to broaden the scope of the screening programme to reduce the future incidence of diabetes. In addition, we can add to the value of people's lives who may thus avoid the disease. I compliment and congratulate her, and wish her well in her new portfolio. I have no doubt she will discharge her responsibilities effectively. She has all our good wishes in that regard.

1:00 pm

Photo of Feargal QuinnFeargal Quinn (Independent)
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I welcome the Minister of State and we are honoured that she is attending the House on her first day in her new portfolio. She comes here with a huge amount of enthusiasm and commitment. I hope she will place diabetes, and diabetic retinopathy in particular, high on her list of priorities. While I do not have medical expertise, it seems one of the things that can be done is to remind people they can do something about their lifestyles even before being screened. It was interesting to hear Senator Walsh talk about using the stairs instead of the lift. In the 1940s, when I was about six years of age, I remember my father saying he heard a doctor on the radio stating that people were not getting enough exercise. The doctor suggested that people should always run up stairs instead of walking up them. I got into the habit of doing that and my father also did so for many years. The Minister of State can remind people that they can do something about their health through a change of lifestyle.

Both here and abroad, a large amount of research is taking place into diseases that affect the eyes. We must continue to invest in such research which will pay for itself in many ways. An interesting article was published recently on macular degeneration which reported on a successful outcome as a result of stem cell research. Within two years they believe they will be able to solve that problem, although I am not sure of the method involved or whether it will be acceptable to everybody. Nonetheless, it appears it is possible to do something in this regard.

Senator Feeney mentioned how horrific it is to lose one's eyesight. I know of one young woman who was on one of the supermarket customer panels. She had lost her eyesight, but gave great example to others by saying she was not going to let it beat her, that she was going to beat it. She was able to prove that the ability to conquer adversity is within ourselves.

Diabetes affects approximately one in 25 patients in the developed world, and the incidence of diabetes in Ireland is increasing. As the Minister of State told us, it is expected that up to 5.6% of the population will be affected by 2015. In Ireland, diabetic retinopathy accounts for 12% of all new cases of blindness each year. It is the leading cause of blindness in patients between the ages of 20 and 65. After 65, macular degeneration probably affects eyesight more.

Diabetes can affect the eye in various ways, but the most serious effects are through problems in the retina. This is called diabetic retinopathy. Having diabetes does not mean that a person will necessarily have eye problems. However, it is important that regular eye examinations are carried out to ensure potential problems are diagnosed early. That is really the point — it does not cost money, it just involves reminding people to have such checks. Sight loss from diabetes can usually be prevented if diabetic retinopathy is diagnosed and treated early.

I was also interested in another statistic according to which diabetes affects one in every 100 adult Europeans. It can affect blood vessels in the eye causing damage to the retina, but the condition needs to be treated early. Diabetes experts have warned that Ireland has fallen far behind other European countries in the prevention of blindness from diabetes retina eye diseases. Eye complications of diabetes are the most common cause of blindness in this country.

Senator Feeney referred to a debate held on this issue around three years ago. Four years ago, Ireland was a signatory to a European agreement which set specific targets for retinopathy screening. Since then, the Department of Health and Children and Health Service Executive have not made significant progress in expanding diabetes eye screening programmes, the national diabetes screening programme which was recommended by the Department in 2006 and the pilot programme for the west approved in 2007. The Minister of State has given us hope that progress will be made in this regard.

It is known that many people with diabetes in Ireland are suffering unnecessarily from vision loss and blindness as a result of the lack of an effective screening programme to detect eye disease at an early stage. Such a programme would allow for effective treatment interventions. Experts state that between 3% and 5% of those with diabetes develop sight threatening retinopathy each year and many will continue to go without necessary early treatment in the absence of an organised screening programme. It is urgent, therefore, that progress is made on a nationwide screening programme.

Last month, I read a story in the Irish Examiner about a diabetic, Mr. Chris Murphy, who suffers from blindness in one eye and claims the health service was to blame for his condition. According to the article, Mr. Murphy, a former construction worker, "is now terrified when he wakes up every morning, in case he finds he has lost the use of the other eye" and "even now cannot get a full eye check every six months, as he has been advised to do". The article continues:

In August 2000, when he attended the hospital's eye clinic, he was told his appointment had been cancelled and the receptionist apologised for not contacting him. Several weeks earlier, he had moved to London to work but wanted to return to Dublin simply to attend the clinic because of growing concerns for his eyes. He woke up one morning in October the same year to find he was blind in the left eye.

"If that clinic had not been cancelled the blood vessels which had burst would have been seen and lasered, preventing the blindness. That is what the wonderful staff at London's Moorfield Eye Hospital told me," he said. Staff at the London hospital set about treating his right eye and, a year later, through intricate surgery managed to return over 50% vision to his left eye.

I refer to Mr. Murphy's case because it demonstrates that it is possible to address the problem. Professor John Nolan, the consultant diabetes specialist in St. James's Hospital in Dublin, states that the Department and HSE have known for many years that providing diabetes eye screening throughout the country is straightforward and simple, would provide for early diagnosis and treatment of eye conditions and would not cost much to establish. He also noted that eye screening programmes are currently only available on a piecemeal basis in some areas. It has reached the point where screenings are being organised independently, for example, in the north east, north west and Galway, as the Minister of State informed us.

More than 80 people with diabetic retinopathy were referred to the National Council for the Blind of Ireland's services in 2008 alone. How many more people will lose their sight over the next two years before a screening programme is up and running? This is a challenge for the Minister.

The cost of screening and the subsequent treatment of eye disease is often lower than the cost of dealing with diabetic eye disease that has not been detected at an early stage through screening. The failure to detect cases of diabetic eye disease causes terrible human suffering and has a substantial economic impact. We must do our utmost to introduce a screening system to help prevent this avoidable suffering.

The reason I raise this issue is that, on occasion, we hear from people who are seeking more money. A screening programme in this area would appear to offer good value for money because by preventing disease it would save money. I urge the Minister to give it a high priority.

Photo of Maria CorriganMaria Corrigan (Fianna Fail)
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I am pleased to have an opportunity to contribute to the debate and discuss the causes and effects of diabetes and, more important, the framework for the development of a retinopathy screening programme. I welcome the Minister of State, Deputy Áine Brady, and congratulate her on the new and important role conferred on her. I wish her well and have no doubt the competence she will bring to her areas of responsibility will be beneficial.

Diabetes affects people from all walks of life, from the very young to the very old, and is considered by the World Health Organisation to affect 246 million people worldwide. The WHO anticipates that the condition will affect 380 million people by 2025 if nothing is done to slow down the epidemic. In 2007, the International Diabetes Federation noted that the disease had caused 3.8 million deaths worldwide, accounting for approximately 6% of total global mortality. This stark figure places the issue in context as it shows the disease has caused roughly the same number of deaths as HIV-AIDS.

Diabetes can be prevented and its consequences minimised through good management. Early detection is, therefore, crucial. The establishment of programmes such as the national retinopathy detection programme will assist in this regard. It is estimated that approximately 200,000 people in Ireland suffer from diabetes, many of whom are unaware that they have the condition. As other speakers noted, the majority of diabetes sufferers will only be diagnosed when symptoms arise during an acute medical event arising from complications such as long-term, untreated hyperglycaemia. A further 200,000 people have impaired glucose intolerance or pre-diabetes and of this group, 40% will develop diabetes in the next five years if lifestyle changes are not made. In this respect, I was struck by comments made by Senators Walsh and Quinn on the impact lifestyle changes can have.

It is clear that detection and proper treatment are at the core of confronting the challenge diabetes presents in this country. A number of factors make people susceptible to type 2 diabetes. Obesity is one such factor. More than 80% of people with type 2 diabetes are overweight. This makes all the more relevant those programmes we have highlighted, notably in the past 18 months, on the importance of maintaining a healthy body weight and creating awareness of what constitutes obesity and fat levels in our body mass.

Age is another factor which increases susceptibility to type 2 diabetes. Between 90% and 95% of those with diabetes are aged over 40 years. Additional factors are a family history of diabetes and physical inactivity. The condition can also occur during pregnancy.

Given my background, the role emotional stress and anxiety can play in the onset of diabetes and in exacerbating the problem is of particular interest to me. People are living highly stressed lives leading to irregular and chaotic lifestyles. This is often evident in eating and physical exercise patterns. Furthermore, grief, worry, anxiety or the death of a close loved one can contribute to the alteration of blood sugar levels and result in the onset of the disease. In the present challenging economic times many Irish people are suffering from stress and anxiety as a result of the economic downturn, thus heightening the risk factors associated with the onset of diabetes.

In congratulating the Government on its continued commitment to mental health I urge that in these times of limited resources we carefully and specifically target expenditure to ensure it is spent most effectively on meeting the most prioritised needs.

I was struck by a further comment made by Senator Quinn concerning the importance of reminding people of what we can do. When people feel a loss of control and start to develop a sense of helplessness about their lives it can make a significant contribution to anxiety and stress. Identifying areas over which we have control is key to addressing this issue. For this reason, I endorse Senator Quinn's comments on the importance of having a programme of education to raise awareness of factors over which people can have control. It can assist in giving back a sense of control to people and give them the opportunity to identify areas of their lives for which they can take responsibility and manage. Practical information for people is very empowering.

Studies undertaken in the United Kingdom by the National Institute of Diabetes and Digestive and Kidney Disease and the diabetes trial unit at Oxford University have shown conclusively that effective control of blood glucose in an effort to keep the level as normal as possible is favourable in preventing and delaying the progression of complications of diabetes. The study further showed that there was a consequent 76% reduction in the risk of developing eye disease.

The Institute of Public Health published a report, Making Diabetes Count: What Does the Future Hold?, which provides the best possible estimate for the number of people both diagnosed and undiagnosed in Ireland today. It predicts there will be a 37% increase in diabetes in the Republic of Ireland over a ten year period. Dr. Kevin Balanda, the associate director of the IPH, predicted that the prevalence of diabetes in adults in 2015 will be 5.6% of the population or approximately 200,000 people. The vast majority of the increases in cases of diabetes is for type 2 and many of these will occur due to adolescent obesity and a lack of exercise, which are undoubtedly two of the most common causes of the epidemic of this disease.

I am conscious of stating the obvious, but adolescent obesity and a lack of exercise are factors within our control. When we consider the cost of diabetes, personally and economically, it makes sense to emphasise immediately the need to take back control of the factors over which we have control. Given the cost of diabetes on a personal level, the impact it has on a person's health and their quality of life — losing one's eyesight is very significant — and the economic cost to the State in meeting the needs of people who suffer those consequences, undoubtedly the retinopathy programme is money well spent. It is an investment in our people's health and our health service.

I welcome the adoption of the principles and continued roll out of the framework in the west. I ask the Minister of State to ensure a comprehensive system is put in place to evaluate the programme, that we then learn from that evaluation, make whatever adjustments are necessary and then roll out the programme in the rest of the country as soon as possible. This is something which will ultimately add to people's lives and will save the taxpayer and the Exchequer money in the long term.

Photo of Liam TwomeyLiam Twomey (Fine Gael)
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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.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Áine Brady, and wish her the best of luck in her new portfolio. I have no doubt she will do an excellent job.

I welcome the opportunity to say a few words on the issue of diabetes from which a considerable number of my friends suffer. The word is that one never knows one is going to get diabetes until one has it, and then it is too late to prevent it. Will all this screening prevent people from getting diabetes? I have always been of the opinion that 250,000 to 260,000 people in this country have diabetes but do not realise it. The Minister of State said the figures were somewhat less and, if so, I am delighted to know this. It is because we are getting on top of things and people are more informed about diet and health. Obesity is increasing, yet we have never had as many fitness centres, as many people walking or cycling, or as many involved in sports. One would wonder where it is all leading. Diet must be the main problem.

Diabetes affects nearly all the organs of one's body. If it can be prevented, everything possible should be done to do so. Senator Twomey mentioned that a simple blood test administered by a doctor or nurse could be useful. I presume it would only reveal whether one had diabetes and not whether it was coming down the track.

I have some questions about the roll-out of the screening programme in the west. The Minister of State said it would be rolled out in the four Health Service Executive, HSE, areas. Will the western region be the last one?

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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It will be the first.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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When is it hoped the programme will be rolled out to all other regions? Will the programme be situated in a designated place in the western region, such as University College Hospital Galway, or will it be in several hospitals in the region? As the Minister of State understands, the western region is very large geographically. I hope the programme will be rolled out in a number of areas in the region.

Photo of Pat MoylanPat Moylan (Fianna Fail)
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Does the Minister of State wish to reply?

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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Yes.

Photo of Pat MoylanPat Moylan (Fianna Fail)
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I congratulate the Minister of State and wish her well, as I was not here when she first spoke.

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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I thank the Cathaoirleach and all Senators for their good wishes. As Senators know, I am only in office for one day, but I will give as much information as I can, although the Cathaoirleach did give me the option of not responding. I appreciate the trouble Senators have gone to in making their statements and I have listened seriously to what they have said.

To answer the question asked by Senator Burke, the programme is being rolled out first in the HSE western region, and funding of €750,000 is available in 2009 for that roll-out, which will consist of a mixture of mobile and fixed units. There is an issue with recruitment because recruitment generally is on hold, but because diabetic retinopathy is a priority for us, we are considering the position and discussing it with the Minister for Finance. The funding is in place for the positions. That recruitment has been put on hold generally is a worry, but we hope the programme will go ahead in the west in 2009 because the funding is in place. In the years after that, resources permitting, we will introduce the programme in the other three HSE areas. A key recommendation of the diabetes expert advisory group was the development of a shared care model and in this regard joint general practitioner-specialist clinical guidelines have been developed.

Many Senators spoke about preventative measures, including Senator Fitzgerald, who opened on that point. Prevention is important. As Minister of State with responsibility for health promotion I am committed to the development and implementation of various initiatives aimed at addressing lifestyle conditions which can lead to the development of certain chronic diseases such as type 2 diabetes, which accounts for 90% of cases of diabetes in Ireland. It is considered that one of the factors leading to the increased prevalence of type 2 diabetes is the rise in excess weight and obesity in our population.

As Senators are aware, my predecessor, Deputy Mary Wallace, recently established an inter-sectoral group comprising representatives of all stakeholders, including experts from Government Departments, agencies, the food industry and relevant non-governmental organisations, to oversee the implementation of the recommendations of the task force on obesity and to address general lifestyle issues related to chronic diseases. The first progress report from this group was published last Friday and I will continue with the process and give priority to tackling obesity in particular. I listened carefully to what Senator Twomey said about developing wider screening programmes. This will be considered in the context of the new GP contract and primary care strategy.

If there are any other issues I have not been able to answer today, I will return to Senators with the answers.

Photo of Pat MoylanPat Moylan (Fianna Fail)
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When is it proposed to sit again?

Photo of Maria CorriganMaria Corrigan (Fianna Fail)
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At 2.30 p.m. on Tuesday, 28 April 2009.