I welcome the Minister of State, Deputy Butler, to the House. The first Commencement matter is from Senator Cosgrove. Tá ceithre nóiméad aici.

Gabhaim buíochas leis an gCathaoirleach agus cuirim fáilte roimh an Aire Stáit. I will raise this today because it is very personal to myself. I have osteoarthritis in both my knees. It has been gradually getting worse.

I will give some figures about it. More than 577,800 people are living in Ireland with chronic joint pain and restricted movement as a result of osteoarthritis. People living with osteoarthritis experience a much poorer quality of life than those without. I have unfortunately learned this. I was late even coming over here and I was struggling to run. Irish people living with osteoarthritis are four times more likely to have three or more chronic conditions along with their arthritis. Due to the ageing population, we expect to see this number growing by between 20% and 30% by 2050. In my case, it is hereditary. Both my parents had osteoarthritis and I can see, first hand, how it reduces your ability to move. That is the whole point I am making today.

Historically, the medical response to osteoarthritis has been to rely on surgical interventions such as knee and hip replacements. Apart from the trauma that any surgery inflicts on patients, it is an expensive practice, costing the health service around €112 million per year. Recently, it was great to attend a policy briefing in the audiovisual room that outlined an alternative response to osteoarthritis and the benefits of moving to supervised group education and exercise as a first-line treatment for people experiencing knee and hip osteoarthritis. For example, in my case, when I was diagnosed as having it, I had to get an MRI to say I have osteoarthritis and there was no treatment plan besides just waiting for it to get worse. I have a wonderful GP but there was no referral to physio. There was no emphasis on alternative methods. It was basically, "You know what? You are going to have to wait until it gets worse and then you will get a knee replacement", or else look at injections.

It was wonderful to go to this programme, which is called the Good Life with osteoArthritis Denmark, GLA:D, programme. It was brought to Ireland with the help of grant aid from the Health Research Board. It is through the University of Limerick that the programme is administered in the Irish health system. The GLA:D programme has been embraced by professionals, with over 265 GLA:D-certified physiotherapists delivering twice weekly, eight-week programmes across 45 healthcare settings. It is being delivered in 16 counties in Ireland and over 1,000 patients have benefited from the approach, which treats the condition in a similar way to other chronic conditions, using education and lifestyle choices, such as exercise, to alleviate the symptoms and the impact of the condition. As I said, surgery should be the last resort and it should be avoided at all costs. Research, particularly in Denmark, states that several countries have shown that the implementation of a group education and exercise programme has resulted in a delaying or even total avoidance of surgery among some sufferers.

Osteoarthritis is as much a chronic condition as type 2 diabetes, chronic obstructive pulmonary disease, COPD, asthma and cardiovascular illnesses such as heart disease. Each of these conditions is recognised under the chronic disease management programme, CDMP, and are treated, where possible, in the first instance through education and lifestyle and then with medication. The CDMP - I know the Minister of State knows this - entails six-month medical reviews, including consultation with a practice nurse, blood tests and follow-up GP visits. It would be enormously beneficial to those living with osteoarthritis to benefit from being included as part of the CDMP and that we would have a national strategy where, as soon as you get diagnosed or identify that you have osteoarthritis, a full treatment plan is put in place concentrating on lifestyle, education and physiotherapy, which is done in primary care settings.

Will the Minister of State look at including osteoarthritis in the CDMP with an update on treatment, and look at alternatives for the treatment of osteoarthritis?

I thank Senator Cosgrove for raising this matter, which I am taking on behalf of my colleague, the Minister for Health, Deputy Jennifer Carroll MacNeill.

It is something I am very familiar with because my husband has the exact same diagnosis. It is amazing how lived and living experience can come into a lot of the stuff we deal with every day. To look at the Senator, we would never in a million years think she is dealing with a condition that can be very debilitating at times, when the knees start rubbing off each other.

As provided for under the 2019 GMS GP agreement, the GP-led chronic disease management, CDM, programme was rolled out to adult medical card and GP visit card holders on a phased basis from 2020. The specified chronic conditions included in the programme under the 2019 agreement were type 2 diabetes, asthma, chronic obstructive pulmonary disease and cardiovascular disease. The 2023 GMS GP agreement then expanded the CDM programme to include adult GMS patients with hypertension and all women diagnosed with gestational diabetes or pre-eclampsia.

Under the CDM treatment programme, eligible patients are supported in managing their chronic conditions. Each patient receives two scheduled reviews a year with the GP, each preceded by a practice nurse visit. These reviews include patient education, preventative care, medication review, physical examinations, scheduled investigations and individual care planning. Furthermore, patients with an undiagnosed chronic disease or those who are at high risk of developing a chronic disease are identified on an opportunistic basis, for example, when a patient attends the GP for another issue. This is the issue raised by the Senator. Those who are not diagnosed but are at a high risk of cardiovascular disease or diabetes are entered into a preventive programme. The programme has shown very high uptake, with almost all eligible GPs having signed up to provide the CDM programme and provide improved patient care. An Irish College of General Practitioners audit of CDM patient records showed a notable reduction in emergency department attendance and inpatient admissions, as well as a reduction in use of GP out-of-hours services, while the third HSE report on the treatment programme showed patient improvements in biometric and lifestyle risk factors, including blood pressure, vaccine status, smoking and vaping habits, and weight and BMI.

It is understood that approximately 500,000 people in Ireland live with osteoarthritis. The causation of the condition is complex, and treatment can also be quite complex for patients. Self-management, including maintaining an optimum weight and being physically active, is now viewed as critical in managing the condition. I will take on board what the Senator has said about the GLA:D programme and alternative response group education, and also the national strategy with regard to treatment plans and lifestyle education. Some people are very good at doing that themselves, but others will need support. Self-management support and advice on exercise and muscle strengthening is available through the HSE.

Consideration can be given to future expansions of the CDM programme to include additional conditions. However, this would require rigorous clinical assessment to determine whether the condition concerned is suitable for inclusion in the treatment programme, including whether it would be of added benefit to eligible patients who already receive GP care under the GMS scheme. The inclusion of additional conditions would also require engagement with the relevant stakeholders, including the GPs delivering the service. Any service expansion must also be considered in the context of GP capacity to deliver the service. It should be noted that an expansion of the CDM programme is already planned for this year to include further conditions under the various CDM programmes, including chronic kidney disease at stages 4 and 5 under the treatment programme.

I thank the Minister of State. Given her husband's condition, she knows about this issue. It is a condition that gets worse as it goes on. Times have definitely changed with regard to treatment, and it is now done through education. Both my mother and father have had knees and hips replaced. However, my mother would have been told not to do any exercise, whereas we are at least told that much now. What is interesting with the GLA:D programme is that because it is a group exercise and it is done in primary care centres by physiotherapists, all it needs is additional funding for it to be rolled out in counties that are willing to have it. My GP is in a fabulous primary care service. It needs additional money so that physiotherapists are not only trained in this programme, but have the capacity to deliver it on a group basis. It is easier to do work like that in a group setting because it requires an holistic approach.

As I said, knee operations in both public and private care push up the cost of medicine. It has been proven in countries like Denmark that early intervention is preferable, and surgery should be a last resort. Unfortunately, in Ireland, we are still told that it is inevitable that people are going to have to get their knees replaced. I thank the Minister of State for listening.

I welcome Deputy Conor D. McGuinness and his guests from Waterford to the Visitors Gallery of the Seanad.

Senator Cosgrove makes a valid point. When we talk about expanding the chronic disease management programme, there are many issues that have to be addressed. We understand why including chronic diseases like kidney disease at stages 4 and 5 would take precedence over some other conditions. I give the Senator a commitment that I will talk to the Minister’s officials about the GLA:D programme. The Senator is right that we have learned a lot about how to deal with individual conditions. A lot of walks are now taken in the Portlaw Woods on the softer ground as opposed to the hard ground of the roads. We have learned a lot about that. I thank the Senator for raising this issue. There are 500,000 people in Ireland with a diagnosis of osteoarthritis, so it merits discussion. I will take that back.

I also welcome Deputy Conor D. McGuinness and his visitors to the Seanad.