Emergency care resources 'highly skewed' to North East, study finds

Spending on urgent and emergency care in Ireland varies greatly depending on the patient’s address, according to a new study.

The research from Trinity College Dublin and University College Cork examined variation in per capita spending on GPs, ambulances, Emergency Departments and local injury units by county and by region. It found Louth tops the table at €207 per capita on urgent and emergency care while Wicklow gets less than a quarter of this amount with just over €46 per capita.

The researchers said that hospital emergency care resources are “highly skewed” to the North East of the country and away from the recently re-ordered South and Mid-West regions.

Lead author, Dr Steve Thomas, Director of Health Policy and Engagement, School of Medicine Trinity College Dublin, said the study found large differences in per capita spending at a county level.

He said: “The access to urgent and emergency hospital services differs widely for residents of different counties and regions which immediately raises issues of fairness of access to care.”

The researchers, which also included UCC's Professor John Browne, found that funding for GPs goes from just under €2 per capita in Cavan to almost €40 per capita in Kilkenny and Carlow.

When it comes to spending on ambulances per capita, it ranges from just over €17 in Meath to over four times that amount in Roscommon at just over €71. In 22 counties which have Emergency Departments, spending per capita ranges from a high of €152 in Louth to just over €13 in Monaghan.

The study found the pattern of spending on ambulance services was inconsistent.

“Many rural counties on the Western seaboard such as Donegal, Clare, Kerry, Roscommon and Leitrim are relatively well resourced. The pattern is not consistent as Mayo and Cork, also with dispersed rural populations, are not well served”, noted the study. “Instead, the highest level of resource per capita funding appears to be in the Midland counties of Longford, Offaly and Westmeath.”

The research, published in BMC Health Services Research, examined expenditure, staffing, access and activity data gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics.

Inequities in overall resource allocation by county

Data on costs and activity in 2014 were gathered from both county and regional levels.

In terms of regions, Dublin Midlands had the lowest spending on urgent and emergency care per capita at €105 followed by the Mid West at €120. Dublin South topped the table at €139 per capita.

Dublin South has the highest expenditure in the country on private emergency department and local injury units at €14 per capita while the Mid West, North East, South East and Dublin Midlands all had zero expenditure in the same private expenditure category.

The authors concluded that the results show inequities in overall resource allocation by county, and to some extent, by region.

Dr Thomas said an initial draft of the findings has been sent to key managers in the Department of Health.

He said the system could be made more equitable by more investment in pre-hospital services for counties which do not have local hospitals providing urgent and emergency care. He also added there could be improved accessibility to hospital urgent and emergency services for those in the west and southwest of the country.

The study concluded there were notable differences in utilisation of hospital-based emergency care resources at the regional level.

“(This) indicates that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process”, said the authors.