Chronic obstructive pulmonary disease, COPD, is a major health issue in Ireland claiming the lives of four people daily. It is a lung condition affecting one in 13 adults which hinders the movement of air in and out of their lungs and makes breathing difficult. Despite its manageability, only 20% of those with COPD are diagnosed. Often, this is too late, as diagnoses frequently occur during medical emergencies. This contributes to Ireland having the highest hospital admission rates for COPD in the developed world with nearly two admissions every hour, which is double the OECD average.

While the situation places a financial strain on our health service, costing approximately €120 million annually in hospital admissions, it also puts greater pressure on hospital beds during the winter when acute COPD-related illnesses are more frequent, as these patients tend to stay in hospital significantly longer than the average patient.

Reducing hospital admissions for COPD would significantly ease overcrowding in our emergency departments this winter. It is frustrating that COPD management is feasible yet healthcare delivery falls short.

Under Sláintecare, 24 integrated care consultants were promised to manage COPD care but only eight are in place. General practitioners have primary responsibility for COPD care and were promised to be supported by 30 specialist ambulatory hubs. However, only a fraction of these hubs, and the planned clinical nurse specialists in pulmonary rehabilitation, are operational. I must reiterate that the lack of support services leads to overwhelming pressures on our emergency departments, especially during the winter with COPD patients occupying beds which could be avoided with better community healthcare.

Moreover, socioeconomic status significantly contributes to COPD outcomes in Ireland. The risk of dying from COPD is as high due to poverty as it is to smoking-related causes. Furthermore, there is a staggering 366% disparity in COPD mortality rates between that of a barrister and that of a bricklayer. Factors such as poor housing, low income, limited access to healthcare, types of employment and environmental conditions disproportionately affect those with COPD from lower socioeconomic backgrounds.

We must prioritise community-based COPD care within our health service in the interests of all of our patients.

I thank the Deputy for raising this very important issue. Historically, Ireland has had a very high prevalence of COPD. There can be different factors involved, even climate. The Deputy outlined towards the end of his contribution the public health framework which governs much of this. Smoking was a big factor but also tended to be a socioeconomic issue with regard to its prevalence and scale. As a country, we have taken various measures on smoking which have helped but there are issues around work safety in terms of dust and inhalation. We have improved a much of that compared to where we were ten or 20 years ago so that prevention piece is extremely important. The Deputy is correct to refer to housing also and the quality of it. Those are all areas which will help to prevent COPD.

In addition to that one needs a proper community-based model of care and an acute system of care. In 2019, the HSE developed a COPD model of care which redefined how health services are to be provided to people with the disease. In November 2021, the first national clinical guidelines for the management of COPD were launched. That idea was to have the right care delivered to people with COPD at the right time and in the right place. The chronic disease management programme commenced in 2020 and has been rolled out to all adult general medical services, GMS, patients over a four-year period. That chronic disease management programme is an entirely new healthcare service in Ireland and has brought the care for chronic disease further into the community. Its aim is to reduce hospital attendance by patients with one or more of these specified conditions. COPD is a specified chronic disease which falls to be managed under that particular programme.

Through the chronic diseases management contract, as Deputy Naughten has said, GPs are funded to provide structured reviews and interventions in time with the model of care. Each patient receives two scheduled reviews with a GP in a 12-month period, each preceded by a practice nurse visit. Those reviews are to include patient education, preventive care, medication review, physical examinations, individual care planning and scheduled investigations.

In addition to the GP chronic disease management programme, the enhanced community care programme, as the Deputy knows, is a suite of strategic reform initiatives. Under that programme some 3,500 people are being recruited, with 2,800 already recruited. Some 96 community healthcare networks are now operational under the enhanced community care programme, 24 of the 30 community specialist teams, CSTs, for older persons are operational, and 24 of the 30 CSTs for chronic disease management are operational. Progress has been made but I do not doubt that more needs to happen because COPD is a particularly nasty disease which can significantly hamper a person's quality of life. We will continue to work on it.

I want to focus on one contributory factor for COPD, that is, poor housing. Research commissioned by the Department of the Environment, Climate and Communications and produced by the London School of Hygiene and Tropical Medicine has shown that retrofitting of homes of those with COPD or asthma reduces their use of GP, emergency department and hospital services. This is a win for our climate and for our health services. Yet if someone in receipt of the fuel allowance applies for the home energy retrofit grant under the warmer homes scheme today, they will not see the benefits of that until the winter of 2026 to 2027, two winters away.

What is even more concerning is that those living in some of our coldest homes - those built of stone - are completely excluded from the scheme and receive no support whatsoever. This is just not good enough and needs to be urgently reviewed.

I admire the Deputy's ingenuity and creativity in turning a chronic disease management programme into the deficiencies of the grant-based system for retrofitting. That is to be applauded.

I was never shy of that, Tánaiste.

I acknowledge what the Deputy is saying. He is alluding to the fact that there are so many applications and to the capacity of the scheme to provide responses more quickly. There is no doubt, comparing it to before this Government came into power, about the contrast in the volume of retrofitting now going on. An entire new industry is being created as a result of guaranteed funding over the next decade, through the national development plan. It gives the industry confidence in the retrofitting area. We want those in more disadvantaged income groups to get the benefits of retrofitting as quickly as possible.

The Deputy identified a key point which many people who are denying climate change, or who are less than enthusiastic about it, do not address. There is an inextricable link between climate change and public health. If one takes fossil fuels out of cars and buses, one will have a much healthier atmosphere in cities and towns for people breathing the air. Likewise, there are significant public health benefits for people from retrofitting.