There is nothing more frightening than watching someone gasping for their breath. Despite the fact that we live on a windswept island off the west coast of Europe, every day four people die in Ireland due to poor air quality. Two of the key underlying statistics when it comes to these threats are, first, that one in five children in Ireland has asthma and, second, that one in 13 adults has chronic obstructive pulmonary disease, COPD, which is the disease that makes it hard to move air and in and out of the lungs. While so much can be done to manage COPD, just one in 45 adults in Ireland has been diagnosed with the condition. The vast majority of people are only diagnosed when they present with a medical emergency. That is why Ireland has the highest hospital admission rates in the developed world for COPD at twice the OECD average. This is conservatively costing our health service €120 million each year in hospital admissions alone.

As I said, so much can be done to manage COPD. One of the most innovative initiatives in the world is the warmth and well-being pilot scheme, which I launched as Minister in 2016. The pilot aimed to improve the health and well-bring outcomes of people in Dublin suffering from chronic respiratory disease through a home energy efficiency retrofit by making homes warmer and more energy-efficient. Last week, Deputies and Senators were presented with the results of the pilot scheme, which were independently analysed by academic researchers from the London School of Hygiene and Tropical Medicine. The empirical evidence shows that, among other things, there was a reduced usage of GP, emergency department and hospital services and a reduced volume of prescribed drugs - a win for our climate, a win for our health services and, most important, a win for people with chronic conditions, such as asthma and COPD. Yet there is no targeted investment in retrofitting these homes, and the better energy warmer homes scheme for those in fuel poverty has a waiting list of nearly three years. When is the Government going to properly manage chronic illnesses, such as COPD and asthma, and when will it properly support globally significant, innovative pilots, such as the warmth and well-being scheme, to address poor health outcomes in a comprehensive way?

I thank the Deputy for raising this important issue. I know he is doing a lot of work as an advocate to highlight this matter. COPD, formerly known as emphysema or bronchitis, has a considerable impact on the quality of life of patients, families and carers. The course of the disease involves ongoing medical care and, in the case of certain patients, frequent hospital admissions.

It is estimated that 400,000 people live with COPD in Ireland, but only about 100,000 have been diagnosed. It is extraordinary to think that as many as three quarters of people with COPD are displaying symptoms but have not been diagnosed and, therefore, are not being treated or are not being treated optimally. Roughly 1,500 patients die every year as a result of COPD and the disease results in approximately 15,000 hospital admissions.

The COPD model of care was developed by the HSE in 2019 and it redefined the way health services are provided to people with the disease. The national clinical programme for respiratory medicine launched the guideline for the management to COPD in November last year. Through the implementation of these guidelines, the health service ensures the right care is delivered to people with COPD at the right time and in the right place in line with Sláintecare. The chronic disease management, CDM, programme provides a structured management programme for people who have one or more specific chronic diseases, of which COPD is one. The programme commenced in 2020 and is provided to all adult general medical services, GMS, patients.

Through the CDM contract, GPs are funded to provide structured reviews and interventions in line with the model of care. As of 1 October this year, 43,000 GMS patients received planned care from their GP in the community. The model of care also provides a continuum of patient-centred, specialist respiratory integrated care across both community-based ambulatory care hubs and their associated hospital. Through the enhanced community care programme, funding was secured for 30 ambulatory care hub-based specialist respiratory teams, consisting of 295 staff and approximately 100 dedicated pulmonary respiratory rehabilitation providers. A roll-out of these services has commenced in many areas and recruitment is under way to fill the remaining posts. These teams include dedicated specialist physios and nurses, who provide a comprehensive intervention with patient assessment and tailored therapies, including exercise, training, education and self-management.

Before the pandemic, respiratory consultations made up 15% of GP attendances. While respiratory diseases account for less than 6% of inpatient discharges, they account for more than 12% of the bed days used in our hospitals. The developments in the CDM programme are welcome for people with conditions such as asthma and COPD but the difficulty is what happens when GPs makes that referral, because people end up in an Eircode postcode lottery. There is a stark contrast in the number of people waiting more than 12 months for an outpatient respiratory appointment in the regions compared to the number in Dublin, resulting in far poorer health outcomes. When will this Eircode postcode lottery be addressed?

The idea is to manage COPD, diabetes, hypertension, heart failure, and other chronic illnesses in the community, insofar as is possible. If those diseases are well managed in the community, and they can be in the majority of cases, the number of hospital admissions will be very low. However, there will always be people who need specialist care and need to see a consultant or be admitted to hospital. It is absolutely wrong that there should be a major discrepancy in waiting times to see a specialist in one region of the country versus another, and that is not justifiable. Part of the reason for the move to regional health areas is to deal with this. We will establish regional health areas across the country and funding will be based on the population and medical needs of the people in those areas so that funding can be rebalanced in an appropriate way. That is something we need to work on in the next year or two.