Healthcare reform will require investment before savings can be made
Problems with the Irish healthcare system are often apparent through difficulties of access. However, that is not the whole story – as well as waiting times for access to hospital care, there are barriers in access to primary care and delays in Accident & Emergency Department admissions. When the financial crisis occurred in 2008, Ireland still had poorly developed primary and community care services and austerity policies followed leading to continuous cuts to staff and budgets alongside increasing demand for care.
Access
Irish hospitals are working at near full capacity. The number of hospital beds in 2019 (2.9 per 1,000 population) was the third lowest in the EU[1]. Pre-COVID-19, hospitals frequently ran at 95 per cent occupancy rates – above the capacity considered safe[2]. A high utilisation rate of hospital beds can be a sign of hospital efficiency, but it can also mean that too many patients are treated at secondary care level. Official statistics suggest that an enormous 602,832 people were waiting for an outpatient appointment in November 2022 while 80,232 people were waiting for treatment as an in-patient or day case, with further numbers of people on other waiting lists[3]. Among people waiting for an outpatient appointment, those waiting 18+ months numbered 106,047 people while 8,213 people were waiting 18+ months for an inpatient/day case appointment.
It is well known that problems with overcrowding in emergency departments are a regular feature of the Irish system. The Irish Nurses and Midwives Association document that over 121,318 patients, including 2,777 children, went without a bed in Irish hospitals in 2022, the worst year for hospital overcrowding on record[4]. In this situation outpatient appointments and surgeries can be cancelled and effects are felt throughout the system – not to mention the human suffering involved and the risks to safety. The national survey of patients conducted in May 2022 found that 5,278 people (71.1 per cent of those answering this question), said that they waited more than six hours before being admitted to a ward; amongst them, 334 people (4.5 per cent) reported waiting 48 hours or more.
Discharge
Contributing to these problems is inability to discharge people, often older patients, due to lack of step-down facilities, nursing homes and other forms of support in communities. A study suggests that formal care is available to only 24 per cent of those needing care and (amongst the different groups examined) 38 per cent of people aged 65+ have unmet needs for care, as do 34 per cent of disabled adults. It has been highlighted that many hospital admissions could be avoided in Ireland (especially for chronic conditions like Asthma and COPD) if there were improvements in primary care. Thus, community services are not fully meeting growing demands associated with population change, reflected in inappropriate levels of admission to, and delayed discharges from, acute hospitals. With increases in the population, especially amongst older people, the acute hospital system will be unable to operate effectively without a shift towards primary and community services as a principal means of meeting patient needs.
Reform
Social Justice Ireland is concerned that the ageing of the population is not being properly planned for. While we welcomed measures in Budget 2023, such as cost of living measures, notably the expansion of GP Visit Cards, and the commitment to expanding the health service workforce, we regret that Budget 2023 did not make the necessary investment in Enhanced Community Care and expansion of GP and Practice Teams to support delivery of primary and community based care. While recognising the additional resources, we highlight again the lack of transparency in information available that makes it difficult to establish if funds provided to maintain existing services and COVID-19 pandemic expenditure are sufficient within the overall allocation. As noted already, the additional resources committed for the development of the healthcare system during the COVID pandemic should be retained and now fully rolled out to implement Sláintecare. Budget 2023 failed to allocate the resources required to invest in public healthcare in order to deliver the modern, responsive, integrated public health system that the Sláintecare report envisages. Reform will require investment before savings can be made.
[1] OECD & World Health Organization (WHO) (2021). State of Health in The EU: Ireland Country Health Profile 2021.
[2] OECD & World Health Organization (WHO) (2021). State of Health in The EU: Ireland Country Health Profile 2021.
[3] National Treatment Purchase Fund (2023). National Waiting List Data Inpatient / Day Case Waiting List/Outpatient Waiting List