Catherine Noone (Fine Gael)
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I thank the Minister of State at the Department of Health for taking this matter on behalf of the Minister for Health, on whom I call to consider introducing fibroscans to improve the diagnosis of non-alcoholic fatty liver disease, NAFLD. Ireland is facing an epidemic of liver disease. NAFLD is driven by obesity and diets that are high in fat, sugar and salt. Sadly, many are unaware of the risk such diets pose to their health. NAFLD can be managed and prevented from developing, once detected. In the vast majority of instances it is currently not detectable by a routine liver test - generally a blood test. Fibroscans can accurately diagnose the condition in a timely manner. A fibroscan is quick, simple, pain free and non-invasive. If fibroscans were introduced, they would help to address the under-diagnosis of NAFLD. Non-alcoholic steato-hepatitis, NASH, is the more aggressive form that emerges if NAFLD is left untreated. It is a silent epidemic and as many as 80% of people with NAFLD are not diagnosed routinely. Fibroscans are relatively inexpensive and can be performed by GPs. It would make great sense to introduce them, given the incidence of obesity in the country.

Professor Suzanne Norris is a specialist in the area. She has said: "In my lifetime there will be a tsunami of liver disease in Ireland." It is only in recent times that it has been realised liver disease is caused by a diet high in fat, sugar and salt, rather than alcohol. Up until now it was predominantly suffered by males an alcohol-related but now it is presenting in a large volume of younger people and many females.I will be very interested in the Minister of State's response because this makes a lot of sense.

Catherine Byrne (Dublin South Central, Fine Gael)
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I hope the Senator is interested in the response which is wide-ranging, but I will have some notes to add at the end.

Chronic diseases are largely preventable diseases linked with a set of four common risk factors - tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity - and which can remain preventable until late in life. As described in the recent Sláintecare report, they present a major challenge in future health service planning. The demographic profile has changed, life expectancy has risen and the diseases we encounter have changed. Chronic diseases such as cancer and cardiovascular disease now account for over 60% of all deaths in Ireland. The health system needs to reflect these changes and adapt to meet the needs of the current and future populations. Chronic diseases and multi-morbidity require a different type of care that is preventive, ongoing and managed close to home.

Services to treat most chronic conditions are mainly provided in acute hospitals, although significant advances have been made in some areas, particularly diabetes care. The development in 2008 of the national policy framework for the prevention and management of chronic diseases addressed the management of chronic diseases through a reorientation towards primary care and the provision of integrated health services focused on prevention and returning individuals to health and a better quality of life. The Sláintecare report builds on the work that commenced in 2008 under the national policy framework for the prevention and management of chronic diseases. The model of care envisaged in Sláintecare is chronic disease management by multi-disciplinary teams, incorporating evidence-based approaches, care plans, self-management and shared care protocols, which will be community-based. This model of care will offer a comprehensive package of services, from prevention to diagnostic services, disease management and rehabilitation. Referral to an acute hospital will only be for episodes which require specific specialist care, with discharge back to community care, as required.

lt is important to recognise that a significant proportion of the ill health associated with chronic diseases is preventable. Significant progress has been made in the early implementation of Healthy Ireland which provides a solid platform for tackling lifestyle risk factors, social determinants of health and factors which contribute to health inequalities. It also provides the framework within which individuals, communities and sectors can be supported in playing a proactive role in improving the nation's health and well-being and throughout the course of life. In the next decade the focus will increasingly shift to driving monitoring and evaluating implementation. This will be supported by the evolving Healthy Ireland infrastructure. Under the Healthy Ireland agenda, our aim is to prevent much of the chronic disease through action on risk factors and by creating an environment which will support people in making the healthier choices which will reduce their risks of ill health during their lifetime.

Implementation of a range of initiatives is under way, including implementation of the obesity policy and action plan which was approved by the Government in 2016 and which aims to reduce levels of excess weight among the population. Our mission is to get the message of Healthy Ireland into every home and community in order that we can better help and support people in making the healthy changes they want to make but which everyday struggles can make harder to do. It is important that we all work together to deliver clear, simple and consistent messages to encourage people to take those first steps and understand everything they do will count towards a healthier future for their families. No step is too small and the most important thing is to start.

I have held the health promotion and Healthy Ireland brief for almost a year and had the privilege of meeting many people and organisations that are working with us on the Healthy Ireland agenda. I am always struck by how passionate and committed they are about promoting health and well-being in communities. I look forward to continuing our work over the summer and beyond in order that we can support more people in eating, thinking and being well. I will come back to the specific question asked and answer it with a comment I have received in the past few minutes. I know that was a very broad response.

Catherine Noone (Fine Gael)
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That is appreciated. I know of the good work the Minister of State is doing and could not agree more with the general idea that if we are and keep well, we will prevent disease. This is a tangible and specific way to prevent this disease at low cost. The answer is great, but the prevalence of the disease is worthy of a more specific measure. I would appreciate hearing any further comment the Minister of State has to make.

Catherine Byrne (Dublin South Central, Fine Gael)
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I know that the Senator is passionate about this subject, as we all are. Obesity is becoming very prevalent, particularly among young children. I do not have a specific answer to the Commencement matter, about which I am disappointed. I was handed this note before I walked into the Chamber and will read it. The Minister and the Department of Health do not have a role in decisions on the diagnostic tests to be provided for specific patient groups. It is an executive responsibility of the Health Service Executive. The investment decisions should be informed by expert clinical opinion, an assessment of patient need, evidence of effectiveness and budget impact. The roll-out of major new technology should be the subject of a formal health technology assessment. I know that will not satisfy the Senator, but I have not been able to speak to the Minister because he has been in the Dáil Chamber. I will come back to the Senator because her Commencement matter is specifically about fibroscans and I do not believe the answer was adequate.

John O'Mahony (Fine Gael)
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The issue has been highlighted.