Health Conference and Report Launch by Minister for Health and Children

21 October 2009

Health Conference and Report Launch by Minister for Health and Children

The ESRI is hosting a conference to mark the launch of a new report, carried out by researchers from the ESRI and Trinity College Dublin, which examines the impact of demographic change on the demand for and delivery of health care in Ireland to 2021. This important study, funded by the Health Research Board and the Health Service Executive, combines population projections with current patterns and recent trends in health care utilisation, to map out a number of future scenarios for health care in Ireland. This report estimates the impact of demographic change on the demand for and delivery of health care in Ireland. A growing and ageing population will require a significant reconfiguration and intensification in the use of health care resources and our analyses show that current health care practices will become increasingly unsustainable in the face of demographic change. Our findings suggest a number of developments that need to occur in order to successfully shift the emphasis of care from acute hospitals to primary, continuing and community care. Such a transition will be challenging given the changing demographic structure in Ireland.

Date: Wednesday, 21 October 2009

Time: 0830 to 1300

Venue: The ESRI, Whitaker Square, Sir John Rogerson's Quay, Dublin 2

08:30 Registration and Coffee 09.00: Opening of conference by Ms. Mary Harney TD, Minister for Health and Children Chair: Dónal de Buitléir, HSE Board 09.15: “Demographic and Epidemiological Change in Ireland to 2021” Prof. Richard Layte, ESRI 09.30: “Day and Inpatient Services in Acute Public Hospitals” Prof. Miriam Wiley, ESRI 10:00 “General Practice in Ireland: Future Demand for Services and Supply of GPs” Dr Stephen Thomas, TCD 10:30: Tea/Coffee 10:45: “Outpatient Care in Ireland to 2021” Prof. Richard Layte, ESRI 11:15: “Irish Community Drugs Schemes: Recent Trends and Future Growth” Dr. Kathleen Bennett, TCD 11:45: “Requirements for Long Term Care in Ireland to 2021” Ms Maev-Ann Wren, TCD 12:15: “Coping with Demographic Change: Inter-Sectoral Challenges” Prof. Richard Layte, ESRI 12:30: Closing Comments: Prof. Frances Ruane, ESRI and Chair of the Expert Group on Resource Allocation and Financing in the Health Sector A period of discussion will follow each presentation.

For further details please visit the webpage. Full Media Releases with contact details below.

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “Demographic and Epidemiological Change in Ireland to 2021” Richard Layte (ESRI), Edgar Morgenroth (ESRI) and Charles Normand (TCD)

• Our projections estimate that the population will grow overall from 4.2 million in 2006 to 5.1 million in 2021 assuming positive but decreasing migration, with population growth rates highest in the first 5 years of the projection (2.3%). If migration falls to zero early in the projection horizon, population growth will moderate to 4.71 million.

• Significant population ageing will occur with the proportion aged under 5 projected to fall absolutely (by 32,000) and relatively (by 1.2%). Those aged 65+ will increase from 11% to 15.4% of the population, with the proportion aged 85+ doubling from 1.1% to 2.1% of the population. This is an absolute increase of almost 58,000 individuals.

• Fertility rates have been consistently lower in Western and Northern counties. Population growth in commuter counties around Dublin has led to higher rates of fertility in these areas.

• Death rates in Ireland have been falling for several decades but there has been a sharp decrease in rates since 1999. For men, life expectancy increased from 71 in 1986 to 76.8 in 2006. Women's life expectancy increased from 76.8 in 1986 to 81.6 in 2006. Increasing life expectancy is likely to continue but the rate of increase will moderate over time.

• Population growth rates will be highest in Meath (61%), Laois (48%) and Cavan (44%) but population ageing will be most pronounced in Western and Southern counties.

• Epidemiological projections suggest that the prevalence of cardiovascular disease, diabetes and cancer, three of the main drivers of acute care utilisation, will increase by 12% by 2021. However, levels of disability in the population aged 65+ have been falling and this trend is likely to continue.

***

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “Acute Public Hospital Services: Challenges for Reform in the Context of the 'Preferred Health System'" Miriam Wiley, Jacqueline O'Reilly and Aoife Brick (ESRI)

• Factors which have been highlighted as important in the transition to the 'preferred health system' of providing more care in the community and reducing reliance on acute hospital services include the increased use of day services and reductions in hospital length of stay.

• Day case rates vary across procedures within hospitals and by procedure across hospitals. If all hospitals in 2006 were delivering specific procedures at the day case rate of the best performing hospitals, the number of day cases, in place of elective inpatient cases, would have been 15% higher than that actually achieved in 2006.

• While recognising that greater use of 'day case' procedures could improve efficiency in Irish acute public hospitals, the achievement of this objective may necessitate customisation of this policy for individual hospitals and for specific procedures.

• Just 10% of patients accounted for almost 50% of inpatient bed days in 2006. These so called 'high users' were older, poorer, sicker and more likely to be medical card holders than other users. While treatment in other care settings may be equally or more appropriate for many in this group, any attempt to reduce bed day utilisation while continuing to meet their needs may prove complex.

• There is considerable variation in average length of stay across hospitals and hospital groups. After controlling for a range of relevant patient characteristics, voluntary and special hospitals were shown to have a higher than expected average length of stay while regional and community hospitals had shorter stays than expected.

• Shifting the emphasis of care from acute hospitals to primary, community and continuing care services will be challenging. This transition will require a program of reform targeted at individual hospitals and specific procedures to increase day case rates. The fact that variation in length of stay is higher in voluntary and special hospitals requires further assessment. The finding that patients with long lengths of stay are often older medical card holders suffering from multiple chronic conditions means that responses will need to recognise the complex health needs of this group

***

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “General Practitioner Care” Stephen Thomas (TCD) and Richard Layte (ESRI)

• Even to maintain the current and inadequate ratio of GPs to population, there need to be over 350 more GPs by 2021, given current patterns of recruitment, training and retirement of GPs and projected population trends. If Government immediately implemented stated policy and increased its training to 150 GPs per annum, this would make a substantial impact on the shortfall.

• The increasing average age of GPs and earlier retirement means that the ratio of GPs to population is decreasing just as population demand for GP care is increasing due to demographic change.

• If the target were for Ireland to increase the supply of GPs to the EU average, as could be necessary for the preferred model of care, there would be a shortfall of 1,800 GPs from this target by 2021. Increasing training to 150 per year would reduce this shortfall to 1,500 in 2021, assuming that emigration of GPs from Ireland halves.

• Apart from expanding medical and GP training, other policy responses to the shortage include altering the skill mix, increasing temporary migration, encouraging later retirement and reducing the start-up costs for GPs. In particular, Government should consider using nurses and pharmacists to take on some of the work of GPs.

• Ireland has a very low ratio of GPs per 100,000 population compared to most other Western European nations. Ireland has around 56 GPs/100,000; only the Netherlands has a marginally lower ratio, with several countries having over 100 GPs per 100,000 (namely France, Austria and Germany).

• The current GP distribution reveals a particular shortage in commuter belt counties such as Meath, Kildare and Laois. If population and GP placement trends continue, by 2021 most inland Leinster counties will have very low GP to population ratios (under 40/100,000).

• Demographic change will increase total GP consultations by 20% by 2015 and by 33% by 2021. This increase is strongly related to age, particularly for men. Men in the group aged 81+, have almost six times the number of GP consultations as men aged 16 to 20.

***

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “Outpatient Services” Richard Layte (ESRI)

• Analysis shows that there was a 44% increase in total volume of outpatient consultations between 2001 and 2006 in the old Eastern Region Health Authority Area. This increase is not uniform over age groups however. Among those under the age of 18 there has been an increase of 17% in total consultations whereas among those aged 18 to 64 and 65+, the number has increased by 47 and 58% respectively. These growth rates outpace population growth rates within age groups.

• The average number of outpatient consultations among older age groups per capita is far higher than among younger age groups. The average number of consultations per year among those aged between 18 and 64 are almost three times greater than for those aged under 18. The rate is over three and a half times greater for those aged 65 or more.

• Outpatient consultations could increase by almost 25% by 2021. The proportion of consultations among those aged under 18 is projected to fall from 9.9% of the total in 2006 to 8.9% by 2021. Among the middle aged group we also project a fall from 74% to 69%. The share of consultations for those aged 65+ will increase from 16% to 22%.

• Assuming that patterns of referral between hospital networks do not change, the North Eastern and South Eastern networks are projected to experience the highest levels of growth at 29% and 28% respectively by 2021. At the other end of the scale the Dublin North-East and Mid-Western networks are projected to experience the lowest levels of growth at 14 and 17% respectively.

***

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “Pharmaceuticals” Kathleen Bennett, Lesley Tilson and Michael Barry (TCD)

• Approximately 55 million prescription items were paid for by the Primary Care Reimbursement Service in 2006. This represents an increase of 10% on 2005. The GMS scheme (medical card scheme) accounted for 74% of all items prescribed, the Drug Payment Scheme 22% and the Long Term Illness Scheme 4%.

• The high year on year increases in prescriptions and costs reflects the prescribing of newer, more expensive medications and an increased volume of prescribing.

• The number of prescription items increases strongly with age. At any specific age women are prescribed a larger number of medications than men on average. Older groups are also prescribed more expensive medicines on average than younger age groups.

• Assuming previous trends in prescribing, the total number of prescription items in all three schemes is estimated to double by 2021 compared to 2006.

***

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “Long Term Care” Maev-Ann Wren (TCD)

• Between 2006 and 2021 the numbers of people aged 85 and over in Ireland will more than double from 48,000 to nearly 106,000; those aged 74-84 will increase by over a half from 157,000 to 248,000.

• Whilst the number of older people in the population is rising, levels of disability for those aged 65+ are actually decreasing. Trends suggest the proportion aged 65+ with a severe disability will fall from 20% in 2006 to 18.6% in 2021.

• Over 13,000 additional residential, long-term care places or a 59 per cent increase will be required by 2021, compared to the number of places required by older people in 2006, if the present uptake rate of residential care by older people with disabilities continues.

• Proposed reductions in acute bed capacity with the implementation of an integrated health system combined with increased participation by women in the paid workforce could increase the need for non-acute beds for older people to over 21,000. The proportion of long-term care beds required for so-called “intermediate” care such as convalescence and assessment would increase.

• Since women provide the majority of informal care for older people, increased participation by women in the paid labour force may increase the demand for residential long-term care and formal long-term care in the community.

***

Media Release Embargo: 00:01 a.m. Wednesday 21 October 2009 “Coping with Demographic Change: Inter-Sectoral Challenges” Richard Layte (ESRI)

• Demographic change in Ireland will be a significant challenge to 2021 that will continue intensify

• Current practices will be increasingly unsustainable. This will demand a reconfiguration of services and an intensification in the use of resources with substantial improvements in levels of efficiency

• Within primary care, a speedy and full implementation of the Primary Care Strategy (2001) would make better use of existing resources and moderate the impact of supply constraints among GPs.

• More and better use should be made of other health professionals in primary care such as practice nurses and pharmacists although this may require legislative changes. A move to the 'preferred health system' would make reform of primary care even more critical.

• A substantial proportion of resources in Irish outpatient care are expended on monitoring and maintaining chronic health conditions that could be just as successfully managed and more cheaply managed in primary care.

• The HSE's preferred health system strategy sets out a reduction in acute hospital beds by 2020 through a reduction in average inpatient length of stay. The inter-dependency of health care sectors underlines the need to think about reform on a system-wide basis. A transition to the preferred health care system model will require development of both primary and long-stay services as well as social care services if it is to be practicable and not lead to a severe degradation in the level and quality of service.

***

Members of the Media are invited to attend the Conference. For further details please visit the web page at www.esri.ie

Link to Publication