Averil Power (Fianna Fail)
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I welcome the Minister of State to the House. The national asthma programme was developed in 2010, modelled on a successful pilot project carried out by the Asthma Society of Ireland. The aim of the programme is to bring about a reduction in asthma deaths by 90% over ten years and a 10% reduction in hospital admissions, out of hours and emergency department visits over three years. This programme has already been a successful pilot.

It is now three years since the inception of the programme, but it has not been officially signed off and patients are not enrolled to take the programme forward. As a result of the commitment not being given to this initiative, emergency admissions for asthma patients increased in 2012 by 20% from the previous year. This is unfortunate, because asthma is an extremely manageable condition. There is no reason somebody whose asthma is being managed properly and who is on proper medication should find himself or herself being brought to hospital or suffering from an acute attack. We have the medicine to prevent this and we have the procedures by which asthma can be managed, but unfortunately patients are not engaged in proper asthma management programmes like those that are standard practice in other countries.

I have tabled this matter today so as to urge the Minister of State to ensure that in next year's budget, priority is given to the roll-out of the asthma management programme put forward by the Asthma Society of Ireland. I urge him to ensure that the necessary staff are provided and that the 17 clinical nurse specialists required for the roll-out of the programme are recruited. The programme must also be included in the HSE's service plan. The Asthma Society of Ireland also raised the issue of the new GP contract. GPs are an essential point of access to the health service and they are the people those with medical conditions see most frequently. It is essential to ensure that all GPs are properly trained in this regard and that they give priority to helping people manage their asthma. As the Minister of State is aware, approximately 470,000 people in Ireland have asthma - one out of every ten adults and one out of every five children. People with asthma make up the largest chronic disease group in the country. The majority of those affected are under 14 and their quality of life is badly affected by the condition.

Other issues that must be examined include education on the condition. The Asthma Society of Ireland provided me with some excellent materials it has developed for schools. We need to ensure the education system and teachers are given greater training on managing this, particularly PE teachers. Many young people only develop asthma in their teens and the PE teacher could well be the first person with them when they have an exercise induced attack. There is a need for action across the board on this issue. Resources are also needed and if these are put into the right area and into prevention and management of asthma, this would save the health service significant moneys over time.

As matters stand, people unnecessarily find themselves on nebulisers, etc., in emergency departments. This would be avoidable if resources were put into the primary care area. Other European countries, such as the UK and Finland, have shown how this can be done. They have advanced the primary care model and patient self-management, through having GPs train patients in how to manage their condition and to manage it with a peak flow meter and to respond when they realise they are in trouble. In Finland, a similar programme to that proposed by the Asthma Society of Ireland resulted in a 90% reduction in deaths, an 85% reduction in hospital admissions and a 50% reduction in the cost of treating each patient.

I tabled this matter to highlight this issue for the Minister of State. I acknowledge we are heading into the budget process and that there are many priorities for next year in the Department of Health. However, I stress that smart investment in this area can save significant money and can also save lives.

Alex White (Dublin South, Labour)
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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.

Averil Power (Fianna Fail)
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I thank the Minister of State for the positive tone of his reply. I welcome the fact that he met with representatives of the society last week. This is a very important issue and I am glad that it is a priority for the Minister of State heading into the budget process. I am encouraged by his response. The Minister of State mentioned that it is hoped that the model of care will be prepared before the end of the year. Will that be finalised early enough for the first phase of implementation to begin next year? I am conscious that the budget is in October and if proposals are to feed into that budget process, they need to be completed quite quickly. Nonetheless, I welcome the positive note that the Minister of State has brought to the issue this evening.

Alex White (Dublin South, Labour)
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We are moving that on as quickly as we possibly can.