 |
 |
 |
|||||||||||||||||||||||||
 |
|
 |
|||||||||||||||||||||||||
 |
 |
 |
|||||||||||||||||||||||||
|
137,915 registered members
|
 |
||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||
Health reform- illusion or reality?
[Posted: Wed 21/10/2009 by Niall Hunter, Editor]
Predicting the future with any degree of certainty is an inexact science at the best of times, especially when dealing with the future trends and needs of our health services.
However, this is what experts at TCD and the ESRI have attempted to do in a new report just launched. They have reached some insightful but at the same time worrying conclusions about our health service's ability to cope with future demographic trends up to 2121.
Not only this, but they have very strongly suggested that Mary Harney and Brendan Drumm's vision of a more efficient and user-friendly health service reoriented away from hospitals into the community will, contrary to the perceived wisdom, not come cheap and will in fact cost a lot of money.
They warn that past trends are not always an infallible guide to future developments, and factors can combine in unexpected ways so the projections have to be seen as "probabilistic".
"Probabilistically", however, things don't look too good, judging from the report.
The report predicts that, even taking into account the recent economic downturn and its effect on migration, there will be an increase of at least 11.2% in our population by 2021 and depending on migration trends, it could be as high as 21%.
There will be a significant increase in the proportion of the population over 65 years of age and this will clearly impact on healthcare delivery by increasing demand on services. In fact, the report says all the main service areas will most likely experience substantial increases in demand.
The report says on the basis of current utilisation, population growth and ageing would indicate a need for 5,214 more inpatient beds and 1,022 more day beds in hospitals by 2020.
Given that current health service policy is marked by an aversion to adding to acute bed numbers, to put it mildly, creating the alternative primary/community health services model to meet this extra demand is, as the report notes, going to be challenge that may be insurmountable.
Take GP numbers, for a start.
The currrent EU GP average is 87 per 100,000 population, whereas Ireland's is one of the lowest in Europe at 56 per 100,000.
The report clearly shows that we do not have enough GPs now or into the future, even if population, healthcare demands and service organisation were not to change.
"Retirement among Irish GPs and increasing part-time working will mean that Ireland will not be able to maintain the current low (GP to) population ratios to 2021 with current supply, even assuming that all those who trained in the Irish system end up practising medicine here."
The report states a move to the new integrated health system,with less emphaisis on hospital care currently planned by the HSE would require, at the very minimum, an increase in the ratio of GPs to population to at least average European levels.
The report therefore points to a probable need of having to train at least 250 GPs per year. At present, we only train 120 a year and the HSE has, for cost reasons, recently shelved plans to increase this to a modest 150.
The document also points to a particular challenge in terms of providing long-term healthcare, particularly for older people. It says proposed reductions in acute bed capacity with the implementation of the "integrated health system" combined with increased participation by women (the traditional carers) 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 "intermediate" care such as convalescence and assessment would increase, the report warns.
Given the current problems in finding suitable care for older patients who have finished their acute treatment, meeting these demands will be a particular challenge for the health service.
The report then comes to some very sobering conclusions.
These may give the health authorities some food for thought as they try to plan services over the next two decades, particularly in terms of whether they are planning things in the right way.
It notes that if current health service practices were to continue, acute bed numbers would need to increase from the current 11,000-12,000 to around 20,000. Under the HSE's planned integrated system, bed numbers could be reduced down to just under 9,000.
The report says some cuts in bed numbers could be achieved through better use of day procedures and shorter hospital stays. Indeed, the HSE is currently busy cutting back on bed numbers as demand for services increases.
The TCD/ESRI report, however, points out that the health executive's projections on future bed needs are based on the assumption that a major part of current hospital activity can be transferred elsewhere, in particular to primary care, as part of the beloved "integrated system."
The report says this policy is sound, but there is a major issue over the extent to which the other sectors to which hospital care can be transferred are in a position to absorb the increased demand for healthcare they will face with the reorientation of services.
It points, for example to the major shortage of GPs that exists under the current system and to the need for a sizeable increase in GP numbers (to at least the European average) if the new integrated system is to succeed.
The report says reaching the EU average level of supply of GPs needed to implement the new health system would, as previously mentioned, require 250 GPs to be trained each year and their retention in the Irish system at the very minimum.
"In this situation, a transfer of workload from the acute hospital sector to primary care looks unrealistic", the report says, even if the Primary Care Strategy was implemented in full and care teams and networks for the majority of the population become "a reality rather than an aspiration."
The report also mentions that the limited supply of GPs will also cause difficulties in any plan to transfer some hospital outpatient work to primary care.
It also points that the desired reduction in length of stay in hospitals is contingent on a major increase in long-stay accommodation, but with the rate of growth in the population over 65 in the next two decades will make this a major challenge.
Keeping up with ageing population rates would require 888 new long-stay places per annum, the report says.
It adds that even more long-stay places will be needed in addition to this, to cater for the planned reduction in acute bed numbers. This would being the yearly long-stay bed need up to 1,423.
Ominously, the report feels this is "a challenging prospect, even if the financial environment were more conducive."
Government and HSE thinking in recent years has been that reorientating care away from the hospital to the community/primary care system should be largely cost-neutral.
The report's conclusion, however, nips this particular canard in the bud. Basically, it is indicating that developing primary care and community care on the basis currenly employed by the Government and the HSE (ie as cheaply as possible) will not work as it will not meet our future, or indeed our current, population health needs.
The clear message from the TCD/ESRI experts is:"the capacity of other healthcare sectors and primary care and long-stay care to absorb a reorientation of care away from acute hospitals is extremely limited at present and over the period to 2020 without substantial and sustained investment."
Or in other words, while you can implement some reform without spending much money, you can't build a more efficient and equitable health service with smoke and mirrors.
The report indicates that the Government and HSE are trying to change healthcare on the basis of "that's all very well in practice, but we need to make it work in theory."
Mary Harney and Brendan Drumm should take note of the TCS/ESRI report. Although they probably won't.
Read the full report here
nk1 Posted:
22/10/2009 10:56 |
|
Do Ms Harney and Prof. Drum even know that this report exists. But alas they follow their own agenda and why should they start taking any notice of anyone else at this late stage . They do what they like when they like and nothing will be done until it is too late. When I read this back I wonder when I became such a pessimist. |
|
brandy Posted:
25/10/2009 15:49 |
|
nk1, Ms Harney and Mr Drumm are two sides of the same coin and follow the ...."heads I win, tales you lose" philosophy of politics that they and their buddies have promoted for decades in this country! The only way to defeat them is to show the Irish people that greed is not the only currency....for that we need sites like this...and a 'decent' portion of the media...here's hoping ! Thanks for your post. |
| To join the discussion, register by clicking here |
 |
About Irishhealth.com | Privacy Policy | Contact us | Why Register? | Make this your home page | Site Map |  |
| Copyright © 2009. All rights reserved. We subscribe to the principles of the Health On the Net Foundation |
