I welcome, the Minister for Health, Deputy Varadkar, to the House and congratulate him on his appointment.
Eye Care: Motion
I move:
That Seanad Éireann:
- recognises the objectives of Vision 2020 led by the World Health Organisation to eliminate avoidable blindness by 2020;
- welcomes the establishment of the HSE National Programme for Eye Care which aims to reduce the incidence of avoidable sight loss through the development and implementation of fit-for-purpose care pathways and referral protocols;
- welcomes the establishment of the Diabetic Retinopathy Screening Programme to screen and treat diabetic retinopathy which is the leading cause of blindness in people of working age in Ireland;
- recognises the strong service delivery record and commitment of a range of different professionals to eye care in Ireland;
- notes the recommendations for a national vision strategy by the National Vision Coalition, in a report called Framework to Adopt a Strategic Approach for Vision Health in Ireland;
- notes the findings by the National Vision Coalition in its report called Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland that five people per week became blind in Ireland since 2010, despite 75 to 80% of blindness being preventable and that up to €76 million could be saved annually if earlier intervention to prevent eye disease and blindness is prioritised; and
- calls on the Minister for Health to act upon the recommendations of the National Vision Coalition for a national vision strategy and to implement cost-effective measures to prevent a further 260 people per year becoming blind in Ireland.”.
I welcome the newly-appointed Minister for Health, Deputy Varadkar, to the House. He was a frequent visitor to the House in his previous capacity as Minister for Transport, Tourism and Sport. The health portfolio poses an enormous challenge for the Minister. However, I have no doubt that he is well up for it and will make a significant impact. It is fitting that on his first visit to this House as Minister for Health we are discussing this important issue.
As the Minister will be aware, more than 220,000 people in this country are either blind or visually impaired, 80%, or four out of every five cases, of which is preventable. By the end of this week, five people in this country will have lost their sight. In four out of five of these cases this could be prevented by way of early detection and intervention. They are frightening statistics.
In 2003, Ireland signed up to the World Health Organization 2020 Vision Strategy, which pledged to eliminate preventable blindness by 2020. Unfortunately, while there have been some successes in Ireland, in real terms very little has happened since 2003. As a result of the inaction of numerous Administrations the people involved in eye care in this country, including all of the NGOs, Fighting Blindness, the NCBI, the medical profession, the pharmaceutical companies and, most important, service users - people who are blind - decided to come together and formulate a strategy. This strategy, described as an overarching vision strategy compiled by all the stakeholders and people affected, was launched in 2013 to great acclaim.
Having read the strategy I am of the view it is simple, focused and targeted. It contains 11 key objectives which I believe any fair-minded person would agree are the correct objectives. Most important, its vision is the elimination of preventable blindness by 2020, in other words, to ensure that the quality of life of the four out of every five people who potentially will go blind in the future is protected and enhanced.
Early intervention is extremely important in all walks of life. As a doctor the Minister will be aware that the earlier one intervenes in any medical situation the better the chance of success. The situation in terms of eye care is no different. The earlier the detection of eye problems, be that glaucoma, cataracts, diabetic retinopathy and so on and the quicker the treatment provided, the more likely sight loss will be stemmed. I hope that today we will get a commitment from the Minister, Deputy Varadkar, that the HSE will take on board the vision strategy and will establish a strategy of its own encapsulating the views, objectives and targets as set out by the national vision coalition.
We have reached the stage in this country whereby a long-term approach to health care is needed. For too long, we have been reactive as opposed to proactive in terms of dealing with situations that present. Investment now will result in savings long term. Between now and 2020 the cost to the State of eye care will be more than €2.2 billion. In 2010, the cost to the State as a result of blindness, sight loss and vision impairment was €220 million. I understand Grant Thornton was retained to undertake a cost benefit analysis-impact study of the cost of blindness in this country, which analysis identified a possible saving of €78 million if proper interventions were put in place and if the goals and objectives of the strategy were implemented. For me, it is a no-brainer. As in other areas of society, early intervention saves money in the long run. However, this is not all about saving money. This is about protecting an invaluable resource for many thousands of our citizens. It is a beautiful day today. While Members here have the benefit of being able to see that beauty and the sunshine, there are others in the Visitors Gallery who cannot, all of whom I welcome. Most of the stakeholders involved in the vision strategy are in the Visitors Gallery now. On behalf of citizen Ireland and the Oireachtas I thank them for their commitment to ensuring that we will reduce the number of people annually in this country who lose their sight.
We owe it to the people who cannot see the beautiful day it is today to ensure that future generations of people in this country who have eyesight conditions will have their blindness prevented. My sight loss was unpreventable. I was born with it. No medical intervention of any kind would have prevented my being 84% blind. However, that blindness in respect of four out of five people in this country could be prevented poses a challenge to all of us, including me as an Oireachtas Member with life experience of sight loss, to do everything in our power to ensure this does not happen. It poses a challenge to the Oireachtas, the Government and all the stakeholders. In terms of the challenge posed to the stakeholders, in my view they have signed up to and stood up to that challenge.
They have put their ideas, proposals and resources behind this strategy. I sincerely hope that tonight Seanad Éireann will unanimously support the motion. I am somewhat disappointed an amendment has been tabled, but I realise it refers to a separate issue related to funding for the deaf community. I will let the Members who have proposed it speak about it, but there should not be any confusion. I hope this House will unanimously support the ideals, objectives, targets and, hopefully, prevention that will happen as a result of this House supporting the vision strategy and the Government implementing it.
I look forward to the debate and the engagement. I particularly look forward to hearing the comments of the Minister, Deputy Varadkar, and to summing up at the end of the debate.
I welcome the Minister, Deputy Varadkar. I have said to him in private in the past and have no difficulty now putting it on the record that, in my view, he is the most capable person to hold the office of Minister in any Department, regardless of who is in government.
I hope the Senator still thinks that six months hence. I thank the Senator.
Of course, being capable and doing the job well are two different things. The Minister has a very difficult job. Funding means he will not be able to do anything near everything that everybody wants, but what is critically important is the choices he makes when it is a question of robbing Peter to pay Paul, which is, sadly, the position we are in from the point of view of health. I hope he thinks long and hard about those choices and tries to make the right one, not just in terms of finance or the statistical breakdown of access to health services, but to look at it in the round and take Irish culture into account in respect of the fact that people live in the north-west and south-west regions. It is vital that we have centres of expertise, but it is equally vital that people can access certain vital acute services within what might be a three-hour commutable distance, that is, an hour and a half one way and an hour and a half home.
I also urge him not to take refuge in the mythology of cross-Border co-operation with regard to the north west when it comes to matters such as cardio-catheterisation laboratory facilities, the provision of radiotherapy and other issues. We will not be able to depend on the Queen to provide adequately for the citizens of this State in that regard.
Those are just a few brief points. The Minister will have as much support as I can possibly give, but as the former Minister, Deputy Reilly, will tell him, I will not hold back if I believe the wrong choices are being made. That is democracy and I would be of no use to the Minister if I did otherwise. I offer him every best wish for the time ahead.
I thank Senator Conway and Fine Gael for tabling this motion. An attempt was made to add a motion to it, but it is being withdrawn as it would take from the motion and we do not wish to dilute the very important issue the Fine Gael Party has put forward. We fully support the motion and welcome the fact that it has been tabled. We are already dealing with some of those choices that face the Minister in the context of what can and cannot be provided. Regrettably, we have seen that under funding provided to Pobal from the Department of the Environment, Community and Local Government funding is being removed from certain organisations. Hopefully, not many of them were connected to the provision of services for the visually impaired or the blind.
Vision 2020 is a global initiative with the noble aspiration of eradicating all preventable forms of blindness by 2020. I do not know if we are on course to achieve that at this stage, particularly when one considers that it has affected approximately five people per week over the last number of years. The core pillars set out in Vision 2020 are facilitating planning for disease control and for the implementation of a specific programme to control and treat the major causes of blindness, and for the human resource developments that will support training of an adequate number of ophthalmologists and other eye care professionals. I do not know what the position is in respect of the figures in that regard, but it is something we should consider. We have seen the example of obstetricians, the shortage of qualified and experienced obstetricians and the difficulties this will cause for the Minister in terms of adequately staffing the 19 centres throughout the country, so it is very important that we have the optimum number of ophthalmologists in training. That brings me to the third pillar of Vision 2020 which is infrastructure and appropriate technology development, to improve the infrastructure and technology and to make eye care more available and accessible to people.
The "Framework to Adopt a Strategic Approach for Vision Health in Ireland Report 2012" highlighted eight principles to be implemented. In April 2014, the "Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland" report, which looks at the situation in Ireland, shows that 75% to 80% of blindness incidence is preventable. The cost per annum of that is approximately €205 million. God knows, the Minister would have many quarters in which those funds could be used if they were available to him. Again, that is the case with many other disciplines. It is critical that we get to the nub of early intervention and preventing diseases, because that is ultimately where the serious cost is incurred. In the neurological area, for example, we are probably spending many billions of euro in terms of the costs. With regard to cancer, the case for early intervention is very clear as well. That is the case in many aspects of public health.
I would like to think this is an achievable target for 2020 and I look forward to hearing the Minister's views on it. It is one thing to use Private Members' time, as Senator Conway and Fine Gael rightly have, to raise awareness of the strategy and its ambitions, but when one boils it down to action, what are we doing about it? What can we do strategically, bearing in mind the inordinate budgetary issues the Department has, to make Vision 2020 a realistic target in terms of eradicating preventable forms of blindness? It will be interesting to hear the Minister's views. Talk is cheap and motions such as this are good for raising awareness, but what are the tangible outcomes? We must state what they can be, rather than just clap ourselves on the back, say we did a good day's work in highlighting this and bringing people involved in the sector to the Visitors Gallery, with everybody going away thinking it was a great debate. Realistically, what is happening? Hopefully, as Senator Conway said, there will be a tangible outcome.
I will not delay the House. We would happily second the motion but I do not wish to steal the thunder of Senator Conway's colleagues. I will allow them to do that.
We would be very happy if the Senator would.
Finally, Senator Conway is a shining example for people who have a visual impairment. As he said, his was a pre-birth condition, so it was not of an avoidable or preventable nature. However, he does his business in a way that is many times better than people who have their full sight faculties. He is an example to anybody who is visually impaired or has suffered from blindness. It has certainly not held him back in any way and I hope that perhaps we can do some work here together today to ensure that the many other people who are suffering from visual impairment can access the services to ensure they can follow in Senator Conway's footsteps.
I formally second the motion and I am delighted the Fianna Fáil Senators agree with it. It is great and another example of the work we can do in the Seanad with cross-party support. I also congratulate the Minister, Deputy Varadkar, on his appointment and wish him the best of luck in that challenging role. I have no doubt that he will be very successful in it.
I am delighted to formally second the motion. Helen Keller once said that, of all the senses, sight must be the most delightful, which is a very true statement. I would like to welcome the Minister to the House. I also welcome the members of the National Vision Coalition who are here for the debate.
It is startling to hear that up to 80% of the world's blindness is avoidable. It is this statistic that the World Health Organisation has focused on in its Vision 2020 programme, which aims to eliminate avoidable blindness by 2020. It is almost ten years since the Irish Government committed to the objections of Vision 2020 and, in those intervening years, there have been many positive developments in tackling the issue of avoidable sight loss in Ireland. The policy document Healthy Ireland, which the Government published in March 2013, provides a framework for action to address the health issues of all, with an emphasis on prevention and early intervention.
The establishment of the HSE national programme for eye care is a key element of this objective, with the focus on prevention and early intervention, equitable access to efficient high-quality care, supports and treatments and the development of cost-effective care pathways, with the person at the heart of the process. The overall aims are to reduce the number of annual cases of preventable blindness and visual impairment and to maintain the vision of those with impairment for as long as possible, enabling them to live independently.
There are currently 224,000 people with low vision and sight loss in Ireland. Five people per week became blind between 2010 and 2013 and this figure is likely to rise as our population ages unless we take remedial action. I thank Senator Conway for bringing this fact to our attention because there are many facts I was simply not aware of. The current Central Statistics Office projections estimate that the number of people aged 65 and older in Ireland will almost double over the period 2006 to 2026. Unfortunately, as we age, we are at an increased risk of vision loss due to an increased likelihood of developing diseases such as diabetes, glaucoma, cataracts and macular degeneration.
Diabetes is fast becoming a global epidemic, with 366 million people living with this disease worldwide. The main cause of blindness associated with diabetes is diabetic retinopathy. Poorly controlled blood sugars, high blood pressure and high cholesterol increase the risk of developing vision problems. The establishment of the diabetic retinopathy screening programme, which commenced in March 2013, has been a very important development in the early intervention and treatment of this condition. The programme offers free, regular screening to people with diabetes aged 12 and over and, at the end of 2014, invitations to attend screening had been sent out to 109,000 people, with the remainder of the 145,000 on the register to be seen by the end of the year.
Traditionally, the provision of eye health in Ireland has been based on a community approach, with the aim of providing country-wide services which are accessible to the service user. The benefit to the client is that they can be seen and treated in their local area by the ophthalmic team, and this fits in well with the emphasis on early detection of potentially serious conditions. The national programme for eye care has reviewed the school eye screening programme currently provided by the HSE with a view to incorporating best international practice on the screening of children. As a result of this review, there will be changes in the national vision screening programme to ensure that children who fail the screening have quick access to specialist services, which is vital. There are also plans to expand the role of orthoptists and optometrists working under the governance of an ophthalmologist, as well as comprehensive training for public health nurses and area medical officers, all of which will have a positive impact on waiting times and patient numbers.
The National Vision Coalition produced a report, The Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland, detailing the impact of sight loss. Not only is it a major personal tragedy, sight loss also has a significant economic impact on individuals, families, society in general and the State. Some 2.1 million work days are lost each year in Ireland for this reason. The financial cost to the Departments of Finance, Social Protection and Health was €386 million in 2012, and this is expected to rise to €449 million by 2020. However, it is estimated that savings of up to €76 million could be made annually if there were effective early intervention and treatment programmes in place. In addition to having a hugely significant impact on the lives of people at risk of sight loss, the return on investment from the State perspective is considerable. This is something we need to consider seriously as our population ages.
The National Vision Coalition sets out in the report the need for us to build on the strong service delivery record and commitment of the various professionals who work in the area of eye care in Ireland. There is a very wide range of services and service providers working in this field, supporting the 220,000 people living in Ireland who are blind or visually impaired. There is certainly a need for a greater level of integration and co-ordination to ensure that resources are used in the most optimal way. The two main areas for us to focus on are preventative services and supports, and also to review how we can make life better for people with sight loss by promoting inclusion, participation and independence for them. I would ask the Minister to implement whatever strategies are necessary to continue the work that has begun and to ensure the objectives of Vision 2020 are met.
I thank Senator Conway and the Fine Gael senators for putting forward this motion. I welcome the fact we will, hopefully, have cross-party support for the motion.
I welcome the Minister, who comes wearing his new hat. We have every confidence that he will not only enjoy his new role but have great success in it. Well done. I thank him for coming to the House.
The most interesting word in this motion on sight loss is "avoidable". This is the real challenge we have in health. If it is avoidable, the question is what do we have to do to make sure it is avoided. Those of us who have good eyesight are inclined to forget the problems that exist for those who do not have good eyesight. When I was in the supermarket business, one of the efforts we went to was to make sure we catered for as many people as we could by putting up a sufficient number of signs with Braille on them to help people who would otherwise have difficulty. Many of us can do things like that in whatever business we are engaged in or whatever way of life we have.
I welcome the motion as it draws attention to a very important area and the ways in which we can make improvements to prevent avoidable blindness. It is very worrying to see statistics which indicate that, on average, one person with diabetes goes blind in Ireland every week. That figure stunned me when I saw it. It is interesting to note that the University of Ulster has just become the first higher education institution in both Ireland and Britain to launch a new specialist course that, it is believed, could help prevent thousands of people every year from losing their sight, namely, the postgraduate professional certificate in medical retina. The course aims to add to the knowledge and skills of already experienced optometrists working in community-based practice and local hospitals. Specifically, the course offers training in a variety of common medical retina conditions, such as those linked to diabetic retinopathy and macular degeneration, two of the main causes of blindness in countries such as Ireland. I wonder if there are opportunities for links with universities in the South. What are we doing in this area and could we link up with that development in the North? Will the Minister comment on the situation as regards possible links and the upskilling of optometrists? Of course, early detection is one of the key issues when it comes to avoidable blindness.
We need a cultural change in Ireland when it comes to eye tests. I was speaking with a German who told me Germans usually take an eye test once a year. Half of all adults in this country have not had an eye test in two years. Do we need to set up mobile stations where people could be tested?
I am not sure how it would work but it seems they have this situated elsewhere. Could we on the other hand provide people with an incentive, such as a tax rebate on an eye test? These could be real, concrete incentives for people to get an eye test, which would save the State money in the long term. Some of those who are not having their eyes tested and whose eyes are deteriorating over time can get into a car and drive it at night. Can that be as dangerous as driving under the influence of alcohol? Should it be mandatory to obtain eye tests every few years? It is something sensible to consider.
In terms of improving accessibility in relation to blindness, I note a French law passed in 2006 providing for an interesting exception to copyright. It requires publishers to make their files available to designated organisations which are then allowed to transcribe books into sound or braille and to distribute them in book or digital form. It aims to allow people with visual disability to access the same materials as others. There may be a more global agreement implemented through the World Intellectual Property Organisation in future. Ireland signed the relevant agreement only last month. Perhaps the Minister will provide an update on the area. We are expecting him to know everything about everything at the moment notwithstanding that he has only been in the job a few hours. It may be that there are libraries and educational institutions that could do more to convert books to digital files so that they are available to people with blindness. In France, a service at vocalepresse.com provides audio access to more than 50 French newspapers on the day of publication. I note we do work on this and that the NCBI provides newspapers, magazines and journals on audio tape and in braille on a regular basis to over 1,500 Irish subscribers. However, might it be that Irish newspapers could provide a more regular, up-to-date service or that the Government could establish a form of assistance so that people with blindness could access a paper on the morning it is published? I would be interested to hear if we can move in that direction.
Having the debate today is just one step in the direction of what we can achieve. It gets us all focused on what we can do. Let us ensure we do not just talk about it and do something. The Minister is very welcome and I have every confidence that he will learn from today's session.
As Fine Gael spokesperson on health in the Seanad, I welcome the Minister to the House and wish him every success in his new role. He will be determined to continue the reform that has been ongoing over the last three years. That reform will bring about a more efficient health service while ensuring that the services that are required will be available to those who need them.
I thank Senator Conway for moving the motion. It is extremely important to discuss the issue. The reports which have issued have demonstrated clearly that if we put the right procedures and preventative mechanisms in place, we can be very successful and avoid dealing with problems when it is too late to intervene. The motion calls on the Minister to act on the recommendations of the National Vision Coalition on a national vision strategy and to implement cost effective measures to prevent a further 260 people per year becoming blind in Ireland. It is extremely important to act. Reports are produced in all Departments which tend to be parked when priority must be given to dealing with the next issue to come along. In this case, we have the evidence that shows we can reduce costs into the future if we take action now. It is interesting to look at the report produced by the coalition for vision health in Ireland setting out a core focus on prevention and early intervention. It is interesting to go through the proposals. The report clearly recommends out the introduction of targeted prevention campaigns for key at-risk groups. That is very important. Building the capacity of the primary and community care workforce to identify early symptoms and refer appropriately is also extremely important.
I have very restricted vision myself. I remember going to primary school and being identified within a month of arriving as having impaired vision and needed eye tests immediately. As a result, I have been wearing glasses ever since. It was the reaction of the primary school teacher who acted immediately. The report recommends the provision of timely and equitable access to a full myriad of early intervention approaches including sight tests and screening programmes. We must examine existing measures and consider where we can introduce improvements to ensure that they are available to those who require it. Ensuring that all future service delivery networks are equipped and resourced appropriately to deliver on prevention targets is about setting those targets and ensuring we achieve them. That is extremely important. We did it in relation to cancer care in respect of which we set clear targets on reform and the delivery of an improved service. We should do the same in this area.
The expansion of screening programmes with a particular emphasis on high-risk groups is recommended. When one is talking about the expansion of services, there is an immediate cost implication. We can look at the services being provided now and consider how we can make them more efficient to deliver a better service. There is a long-term gain in that. The other area we need to focus on is research. I was looking at the issue over the last two to three days and note that a research centre in an American university has identified that people on blood pressure medication have a higher risk of blindness by way of macular degeneration. Research likes that ensures that we can identify why this is arising and take the necessary precautions for those on blood pressure medication by establishing why it increases the rate of macular degeneration leading to blindness. Many people are unaware of the fact that research has shown that smoking can be a contributory factor in blindness also. It is certain groups that are at risk and it is about getting information out there to ensure that we identify the groups that need to be screened and put the appropriate mechanisms and procedures in place to help them avoid blindness.
People are not aware in relation to glaucoma that there are certain groups of people who require an eye test at least once every two years in that regard. A member of my own family was identified has having glaucoma and has, unfortunately, been left with just 38% vision in one eye. That person had glaucoma for quite a while without being identified. I am very conscious that I myself must go for a test at least once every 12 months to ensure it is not there. Many people are not aware of that. If glaucoma is not treated at an early stage, one cannot reverse the damage it has caused. A lot of people are unaware of that also.
There is a great deal we can do. It is about the people on the frontline ensuring they are up to date on what is available and that they identify the groups. We have been very successful with campaigns in various areas. This is one area, however, in which we have not done enough. It is interesting to look at the cost factors.
The document entitled a Framework to Adopt a Strategic Approach for Vision Health in Ireland Report 2012 shows that hospital costs are over €70 million a year and prescription drug costs another €15 million. We can start reducing that huge cost factor by ensuring we take action at a very early stage.
Another issue we are faced with is an ageing population. The elderly population will increase from 535,000 to over 900,000 within 17 to 20 years which will lead to greater demands on the system. Therefore, it is extremely important to put in place the necessary programmes that will reduce the risk of blindness now and such measures will reduce costs in the long term.
I welcome the Minister to the House and genuinely wish him well in his new role. It has been considered a poisoned chalice for a long number of years but I hope it will not be for him and he brings real reform to the health service.
I commend the Government and Fine Gael Senators for proposing a good motion. Normally, when the Government tables a motion in the Seanad we, in Sinn Féin, amend it but on rare occasions, such as this one, we do not. My party supports the motion and believe it should receive cross-party support.
I wish to take the opportunity to commend the work of the National Vision Council - some of its members are seated in the Visitors Gallery - and its component organisations on the work they have done over many years, and in more recent years, as part of the coalition. On a practical basis, the help and support they give people in the visually impaired and sight loss community is an inspiration. On a strategic policy level, their approach to advocacy and building an argument is an example to many.
I want to especially support the call for implementation of a national vision strategy in today's Private Members' motion. We need action more than words and that action, in the main, needs to come from the very party that proposed the motion. I am sure that the proposer supports and agrees with me that it is up to the Government to deliver on the strategy and one cannot look to what Fianna Fáil or any Opposition party did in the past or what they might do in the future. Fine Gael and the Labour Party are now in government and so have an opportunity to deliver. The Minister for Health has a responsibility and opportunity to deliver on the strategy rather than just sit here and listen to us. He is in a much stronger position than any of us to deliver and I hope he does. I also believe that the objectives set out in the motion are achievable if the right energy is focused on the issue.
The stakes are very high because more than 220,000 people are blind or vision impaired in Ireland. That figure is expected to grow substantially due to an ageing population. A total of 13,840 people in the State are blind and the figure has increased by 7% since 2011. The figures are a stark reminder of the significance of our efforts and of what we need to do in this area.
We know from the National Vision Coalition's latest report that despite 75% to 80% of blindness being preventable, five people per week have become blind since 2010. We also know that the total cost of blindness and vision impairment to the State is €205 million per annum.
The report entitled Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland found that 2.1 million healthy days are lost per annum as a consequence of vision impairment or blindness and it cost €205 million in 2010 with a potential to save up to €76 million if a series of cost-effective measures to prevent four main eye diseases are implemented. In its report, the economic impact of a failure by successive Governments to act is quantified in euro and cent. To some degree, it is a damning indictment of the way politics is done and of our political system that advocacy and campaigning groups feel the need to make an economic argument by reducing the problem down to euro and cent. Heaven forbid that a Government would implement a national vision strategy because it is the right thing to do.
Leaving aside the economic cost there is a human cost too which we can prevent if we put in the resources. That is not to say resources are not being put in or I do not welcome what is being spent in this area. I am simply citing the National Vision Coalition's report and other reports that show we can invest much more in preventive measures that, in turn, will save money and prevent citizens from suffering blindness and visual impairment. That is what we need to do, namely, invest more money.
Recommended interventions include screening for diabetic retinopathy, which allows for earlier access to treatment, screening for cataracts and access to surgery when needed. They are simple and reasonable demands which should happen not because they offer an economic benefit but because they greatly improve the quality of life for individuals. It has been internationally recognised that screening and treatment of diabetic retinopathy is one of the most effective interventions ever investigated and prevents 6% of potential blindness in the first year of treatment.
The Government has just six years to eliminate avoidable blindness which is in line with its commitment with the World Health Organization's objective of Vision 2020. It is high time we got on with the job of just doing what we need to do. I commend and support the motion even though it is a Government one. I appeal to the Minister to implement the strategy, put resources in place and support the organisations which have done a huge amount of work and presented him with unassailable and indisputable facts. I look forward to his contribution. Go raibh maith agat.
Go raibh maith agat, a Leas-Chathaoirligh. I warmly welcome the Minister to the House. He has been one of the stand-out performers of the current Government. His intervention in an unrelated issue, with respect to the Garda whistleblowers, was one of the single most inspired political interventions I have seen in modern Irish politics. It certainly had great impact and was critically important for which he deserves great commendation.
I welcome his new appointment. It is an opportunity for him, at this particular juncture in the history of the health service, to kick-start a necessary reform process. That can be achieved in a much shorter timeframe than is widely accepted if he applies vision and energy but I shall let him off for the summer. After he returns from walking the Camino we will expect to hit the beach running in terms of the reform process.
I want to focus on one very small but critically important part of blindness and vision handicap, a factor which will become much more important due to an ageing population and, sadly, the increasing problem of diabetes and grappling more with weight issues. I refer to staffing levels which is a hobby horse of mine and I will sound like a broken record due to mentioning it so much over the remaining term of the current Oireachtas.
At the core of the dysfunction of the health service is a bizarre career structure for doctors and a bizarrely small number of career level doctors in two specialties, namely, family practice and hospital-based specialties. Ireland would be the laughing stock of the world if it were not for the existence of the United Kingdom. The fact that the United Kingdom's health service is nearly as bad as ours somehow acts as a buffer zone in terms of international comparison. A few weeks ago distinguished visitors from the ophthalmic professional community and advocacy community attended the health committee. At the time I was lucky to have an opportunity to get some numerical information from them which stated that Ireland has one ophthalmologist per 110,000 of population while Scotland has one ophthalmologist per 70,000.
In general, United Kingdom figures for any specialty tend to be approximately one third or one quarter of continental European figures which, in turn, tend to be approximately one half of North American figures. I imagine the Minister will get the gist. Germany, Greece and France have approximately one ophthalmologist for every 25,000 citizens while we have one for every 110,000 citizens. If we factor in the existence of community and medical ophthalmologists, the figure comes down a little but it is still greater than the Scottish figure and compares desperately unfavourably.
The Minister will find himself at a unique vantage point as he attempts to reform the health service. He will see in front of him people who he is trying to persuade and behind him people who really should be on his side in trying to forge reform. He will have to look backwards sometimes and realise that the impetus for reform must come from those who are in officialdom as well as those on the front line of services. The Minister will hear different visions of the future. I do not like disagreeing with Senator Burke too often because I regard him and Senator Barrett as the two finest legislators in this House as well as two of the more thoughtful scrutineers of the legislation that comes through. He is not always the most attentive when I am speaking.
Anyway, the record should reflect the fact that the thing which changed cancer care in this country was not that the country with only four oncologists put together a series of bureaucracies that fixed the problem. Rather, it was when the then Minister, Deputy Michael Noonan, stood up on his first day in the current Minister's office and, with a little gentle plagiarism of something I said - for which he has my full permission - stated that there were hospitals in the country to which he would not let a relative of his with cancer go and that the key issue was appointing enough cancer specialists. Cancer mortality rates in the country improved because we went from having four to 35 oncologists. For the duration of my career and beyond I will believe that the success was not because we appointed new national co-ordinating bureaucracies.
In addressing the deficiencies of the ophthalmic services I call on the Minister to keep a laser-like focus on the issue. We have a bizarrely small number of specialists. As with other areas this will need to be addressed if we are to bring ourselves up to international standards and I believe the Minister has a great opportunity to do this.
I will not say much more. I take this opportunity to welcome the Minister in his new role, to wish him all the best and to assure him that he will have 100% co-operation from me in any way possible to try to advance the reform of the health service in any way we can.
I join in the words of welcome to the Minister. I congratulate him on his appointment and wish him well in what is a very challenging Department and in the many challenges he will face in the coming year and a half. I know he is well up for the job and we in this House have every confidence that he will deliver.
I congratulate my colleague, Senator Martin Conway, on bringing forward this motion for debate. I applaud him and compliment him on his ongoing championing of disability issues. Senator Conway is an effective member of the House despite his disability or lack of vision. Certainly, he has plenty of vision when it comes to championing ideas and issues.
I welcome all the visitors to the House from the National Vision Coalition. The statistics are frightening. Five people per week go blind and in total 220,000 people in the country are either blind or vision-impaired. That figure is likely to increase by 20% by 2020. I strongly applaud the work of the National Vision Coalition in bringing together all the health care professionals, service users and those working in the sight loss community. I also applaud the coalition for the perfectly common-sense recommendations brought forward for a national vision strategy contained in Framework to Adopt a Strategic Approach for Vision Health in Ireland Report 2012.
Some of the principles in the report are very much to be applauded. One principle states that any future agenda must include the full agenda of eye health for children and adults with a major emphasis on prevention. Another suggests maximising quality and ensuring the safety of all who access services should be the first consideration at all times. The report states that all services and supports should be provided on a person-centred basis with a core emphasis on adopting a life course approach. It recommends that people with sight loss should have the supports in place to enable them to live fulfilled lives, exercise choice and have total control over their lives. It argues that services should be provided in a seamless manner and that resource allocation and service design should be guided by evidence-based approaches where equality of access to treatment, rehabilitation and support are prioritised.
There should be greater knowledge and public awareness. I hope the debate today will help to foster a better understanding of good eye health and protection. We need to educate the public about the detection of problems and the importance of recognising and discussing symptoms with the appropriate health care professionals.
I was a little concerned to hear a story today to the effect that there are extensive waiting lists in the HSE for people who wish to have a routine eye test. The tests are normally provided free of charge to people with sight impairment but some people must wait up to 47 months to receive an appointment. This is an issue I am keen for the Minister to examine. An eye test with a professional costs only €22.50. We are possibly short-changing people considerably in that regard.
There is a need for public health and education campaigns about the risk of eye disease and injury. These should target all the young people involved in sporting activities. People should be conscious of eye injury in their place of work. Those of us who do a little gardening potentially put our sight at risk when we use strimmers and gardening equipment. A public health campaign to educate people on the potential risks to their sight would be of benefit. We need to promote the importance of healthy lifestyle behaviours to prevent eye disease, especially chronic diseases that have implications for vision. We need to build on the capacity of our general practitioners, pharmacists and allied health professionals to provide advice and information to the public regarding the maintenance of good eye health.
As has been said, between 75% and 80% of blindness is preventable. In 2010 blindness and vision impairment cost €205 million to the Exchequer but investment in cost-effective interventions could save as much as €76 million per annum.
In supporting the motion of my colleague, Senator Conway, I hope the Minister will take on board the significant contributions that have been made on the importance of promoting good eye care, prevention and heightening awareness as well as providing the supports and resources for those who, unfortunately, no longer have full sight capacity. I thank the Minister for being present today for the debate and I look forward to hearing his response.
As no other Senators are offering to speak I call on the Minister to respond.
I thank Senators for their kind words of welcome and congratulation. As I said last week, I do not believe I am going to be able to pour sweet wine from the poisoned chalice.
I do not think for a second that I will be able to solve all the problems of the health service in the next 18 months just through the force of my personality but I hope with a good deal of help from others, and I will need a good deal of help, that I will be able to make things a little bit better over the next 18 months. I want to particularly focus on putting in place a realistic budget for next year, to which we can stick; making some real progress in providing universal primary care to our population, something to which I am very committed as a former GP; reducing the cost of medicines not only for the Government but for people when they go to their pharmacy, as the cost of medicines in Ireland remains very high; making careers attractive again in our health service, particularly, but not only, for doctors, on which Senator Crown touched; and also taking a personal lead on issues around health promotion and the prevention of disease.
I want to thank the Senators for tabling this motion today and my colleague, Senator Conway, in particular. The Government is committed to the provision of effective and responsive public services for people with visual impairment. It is also firmly committed to the prevention of blindness. We are addressing these objectives through overall population health actions and measures specifically targeted at eye health. The Government is committed to providing and developing vision services and supports through health prevention, screening, intervention policies and programmes, all of which contribute to achieving the priority goal of the World Health Organization's Vision 2020, namely, to eliminate avoidable blindness by then.
The core aim of the health service is to maximise the health status of people and to allow them to participate as fully as possible in the social and economic life of the community. The key elements in achieving this are the maintenance of eye health, the prevention of eye disease, early diagnosis of illness and availability of appropriate clinical interventions and supports.
In March 2013 the Government launched Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025. This provides a framework for action to improve the health and well-being of our population over the coming generation, through a greater emphasis on prevention, early intervention and keeping individuals and communities well. The whole-of-Government and whole-of-society approach of Healthy Ireland recognises that often the risk factors for chronic diseases are outside the control of the health sector. Broader societal health determinants such as education, employment and the environment influence the distribution of such risk factors in our population-----
Hear, hear.
-----although we must never forget the importance of taking personal responsibility for our own health.
The projected growth in incidence of chronic disease risks leading Ireland into an unhealthy and costly future. Action is required to create change and try to address these negative health trends before our problems grow larger. In particular, we need to increase the proportion of people who are healthy at all stages of life. Healthy Ireland draws on the existing policies but stresses the importance of effective co-operation and collaboration in order that we implement evidence-based policies. It is about each individual sector helping to improve health and well-being, multiplying all efforts and delivering better results. These are the principles that we bring to addressing the issues highlighted by today's Private Members' motion.
I acknowledge the very useful contribution made by the Cost of Sight Loss Report, commissioned by National Council for the Blind in Ireland. It certainly adds to our understanding of sight loss and its implications for individuals as well as for society as a whole. It is very good example of how we need to understand the impact of ill-health and disability on society. This study estimated the direct and indirect costs of vision impairment and blindness in Ireland at more than €380 million in 2010. It also estimated that at that time there were more than 220,000 people in Ireland living with low vision and sight loss.
I have been Minister for Health for only a short number of days and I have made it clear that I want to spend the next few weeks talking to people, listening to what they have to say, reflecting on what I find and then I plan to focus on some achievable priorities. Nevertheless, I can say clearly that I want to make primary care the cornerstone of our health service. The Government is committed to the development and implementation of a new primary care strategy. This will be based on best evidence and best international models but also on the many examples of excellence that I know can be found already in our own service. There will be renewed focus on prevention and early intervention, the promotion of responsibility and self-care in the management of chronic disease, the provision of care and rehabilitation in the community and close to people's homes. It must be fully integrated with secondary and more specialised care, which people need from time to time. I stress this because these principles are important to the provision of an appropriate service delivered in appropriate settings and by appropriate professionals for the prevention and management of diseases that affect vision, just as they are with the majority of other common chronic diseases and disabilities.
A further issue is integrated workforce planning, in other words, the development of people and roles for a wide range of professional services. Existing structures do not fit the aspirations of this decentralised model. The health workforce needs to be developed and refocused to deliver a greater proportion of care in the community. This will require the development of multidisciplinary teams which, in association with the ophthalmologists, include, for example, specially trained nurses, optometrists, orthoptists and ophthalmic technicians. In this way teams will be able to organise the workload such that, for example, children referred from school screening are seen by an orthoptist in the first instance. Children with refractive errors will be seen by an optometrist. Refining the number of children to be seen by the doctor will release a substantial amount of medical time for eye doctors to diagnose and treat more complex cases in both child and adult populations.
I recognise the work of those involved in the HSE's national clinical programmes on ophthalmology and diabetes. They are good examples of the necessary clinical leadership which is so essential to sustainable reform of our health services. I am looking forward to seeing this in action for myself. I understand that they have the central objective of developing care pathways and referral protocols for the prevention and management of the principal eye conditions, to be implemented through a decentralised community-based care model, with pathways of referral into acute hospital services and back to the community where clinically appropriate. The HSE's national clinical programme on diabetes, which includes the care of children and adolescents with diabetes, was established in May 2010. The purpose of the programme is to save the lives, eyes and limbs of patients with diabetes. From the outset a priority objective was to develop a national retinopathy screening programme. Systematic retinopathy screening on a population basis is clinically effective in identifying treatable eye disease and is cost-effective. Diabetic retinopathy screening commenced in March of last year. This offers free, regular diabetic retinopathy screening to children from age 12 and to adults. Currently, there are some 145,000 people on the Diabetic RetinaScreen register. By the end of June 2014, 109,000 people had been invited to participate in the screening programme. The programme is on target to invite all eligible participants for screening by the end of this year.
Eye health services provided through the public health service are provided free of charge to children and to medical card holders of all ages. Patients with the greatest clinical need are prioritised and treated as soon as possible. However, waiting times for routine referrals are currently over a year in some parts of the country, as was mentioned by Senators earlier. Consequently, the HSE is establishing an expert group to carry out a review of HSE ophthalmic services. It will review what is currently provided and conduct an analysis of resources, including budgets and workforce. The review will draw up a national plan for the service, which will identify any current inadequacies and inconsistencies and how these should be addressed.
People with disabilities, including blind and visually-impaired people, can access specialist disability services, which are provided in a variety of community and residential settings. These may be provided directly by the HSE or in partnership with voluntary service providers, including the National Council for the Blind and the Irish Guide Dogs. I recognise the enormous contribution that these organisations and their staff and volunteers provide to the care, dignity and life experience of those who depend on their services.
I have outlined the breadth of health service provision aimed at protecting people's eye health and, where necessary, providing supports to people with visual impairment. It is based on the goals and principles of Healthy Ireland, rooted in primary care but integrated with and supported by secondary and specialist services for those who need them.
On the particular call for a national vision strategy on top of the existing national programme for eye care, I am certainly happy to give it detailed consideration. I want to issue a word of caution, however. I am only about five days in office as Minister for Health and I have already come across an awful lot of strategies, very few of which I have had a chance to read yet, and I am not sure when I will get a change to read them - it will probably be on the Camino in August. Of those I am aware of already and those that I have read, they are, by and large, behind schedule in terms of implementation and, in large part, seem aspirational.
I am reluctant to expend time and resources developing new strategies only to publish them, launch them amid much fanfare and leave them on the shelf to gather dust. I do not think that serves the interest of anyone interested in health and disability.
The Government remains committed to the provision and development of vision services and supports through health prevention, screening and intervention policies and programmes, all of which contribute to addressing the priority goal of the World Health Organization's Vision 2020 initiative, namely, to eliminate avoidable blindness. Once again, I thank Senators for proposing this motion. I will give its contents full and detailed consideration over the coming weeks and months and I can confirm that the Government will not be opposing the passage of the motion in the House.
Contributions from all Members were very well researched. The knowledge of what the National Vision Coalition has proposed and its research seems to have influenced the contributions. I thank Senator Marc MacSharry for not pressing the amendment, because it would have diluted what we were trying to achieve. I thank the Minister for not opposing the motion. We can take hope from his contribution. He has established an expert group to review the delivery of eye care within the HSE and I suggest the expert group could very easily do its analysis with the research carried out by the National Vision Coalition. As a country, we have committed to the Vision 2020 goal of elimination of preventable blindness. There is not much difference between what the coalition is proposing and what the Minister wants to achieve. I agree with him that we have had too many strategies in the country and too many strategies are sitting on shelves. I will give him a copy of what has been proposed by the National Vision Coalition and I suggest he read it on the plane before he gets to the Camino. He would then have been influenced ahead of time.
I am delighted it is in large print.
It would be remiss of me not to commend Deputy James Reilly, who met members of the coalition when he was Minister for Health. He said that he believed in the concept of strategies. Senator John Crown has already commented on what has been achieved by a very focused strategy on cancer. We are dealing with something that will end up costing the country an awful lot of money in the future if we do not have a focused strategy.
Politicians and political leaders must deal with the here and now but, as we are maturing as a society and coming out of the recession, we must take a more long-term view. It can be achieved because we have achieved consensus across the political divide today. Even if the present Government is not in office after the general election, alternative Governments have signed up to this. That mature approach to dealing with the health of our nation is new to politics, but it is also good for politics. Ultimately, the people who elect us expect us to achieve that.
Yesterday I gave an interview on national media, and this morning I received an e-mail from a lady in Cork. She has a five-year-old boy who has just finished junior infants, and during the year the community nurse called to the school to carry out a routine eye test. The nurse informed the boy's mother that his sight was particularly poor in one eye. That child must wait 12 to 18 months before receiving a proper eye examination, which is unacceptable. Such delays must be eliminated. It is significant announcement by the Minister that an expert group has been set up to review the delivery of eye care within the HSE. There is no reason the vision strategy proposed by the National Vision Coalition cannot inform the process.
Expertise is available to the Minister through the vision coalition. These are people who have given up their time on a voluntary basis to ensure we progress the objective of eliminating preventable blindness. During the coming weeks, if the Minister needs to consult or extract information from stakeholders in the National Vision Coalition, they will be more than happy to accommodate the Minister. This has been a useful debate and I thank Members for carrying out research and making contributions.
I thank the Minister for Health, Deputy Varadkar. With no disrespect to his officials, there was a move to put this into the realm of disability. Eyesight, eye loss and blindness is a disability, but first it is a health issue that leads to a disability. It is appropriate that the Minister, as the senior Minister responsible for health, deal with this. I am glad the motion has received unanimous support, and it is reflective of what we can achieve in the Seanad. When it is the right thing to do, this Chamber is more likely than the other House, with the greatest of respect to the other House, to come together and row in behind it. It has been a good day for the Seanad and a good day for those who are visually impaired and blind. The Upper House has dedicated itself and passed a motion unanimously supporting the establishment of a vision strategy.
Question put and agreed to.
Sitting suspended at 5.20 p.m. and resumed at 6 p.m.