Practices in the health service ‘must change’

THE health service will be unable to cope with demand by 2021 unless changes are made to the way in which healthcare is delivered, according to a report.

Failure to re-organise — including boosting the number of long-term residential beds in the community by almost 900 per annum — will create a need for an additional 5,214 in-patient beds by 2020, as well as 1,022 day beds, said the Economic and Social Research Institute (ESRI). This is due largely to a growing and ageing population. The report predicts:

* The population will grow to between 4.7 million and 5.1 million by 2021.

* Those aged 65+ will increase from 11% to 15.4% of the population.

* The number of those aged 85+ will double.

* Increasing life expectancy is likely to continue.

The ESRI also predicts that the prevalence of cardiovascular disease, diabetes and cancer, three of the main drivers of acute care utilisation, will rise by 12%.

The ESRI warns even if national finances improve substantially, the way in which care is delivered will be “unsustainable within any reasonable budget” given the nature ofdemographic change.

“This demands a reconfiguration and intensification in the use of healthcare resources and improvements in levels of efficiency,” the report said.

The Health Service Executive (HSE) said the ESRI’s findings were “consistent with the strategies being pursued by the HSE’s Transformation Programme (2007-2010) to deliver an integrated health service”. It is working towards delivering more care in the community through primary care teams “where patients and clients can have up to 95% of health and social needs met”. However, with the number of GP consultations predicted to increase by almost a third by 2021, the ESRI says an increase in GP numbers of 300 is necessary just to preserve current GP/population ratios.

Ireland already has fewer GPs per head of population than almost all other western European countries at around 56 per 100,000 of population — the European average is 87 per 100,000. Moving to an EU average level of provision would require over 3,500 additional full-time equivalent GPs by 2021. “In this situation a transfer of workload from the acute hospital sector to primary care looks unrealistic,” the report warns.

It says a reorientation of care away from acute hospitals is a “sound policy” and a “sensible strategic response to the pressures which demographic change will place on Irish healthcare in the decades to come”. However, it warns “the issue is the extent to which other sectors are in a position toabsorb the increased demand for healthcare which they will face with the reorientation of services”.

Age Action Ireland said it agreed with the finding of the report “that there needs to be a shift from hospital care to community care for our ageing population”.

Nursing Homes Ireland (NHI) said it would “seek to meet with the relevant policymakers within Government to start mapping out a solution to this growing challenge right away”.