Demographic pressure and service demand puts community plan at risk

The plan, which was recently published, states there are risks in the capacity of general practice to cope with service demands and in the development of a new contract for the provision of GP services. There is also risk associated with demand-led schemes exceeding funded levels.

In palliative care, there are challenges in respect of the provision of respite care and on the issue of palliative care teams to support consultants working without full teams.

Regarding mental health, demographic pressures in under-18s and in the rising population aged over 65 years will increase demand for child and adolescent mental health and psychiatry of later life services, respectively, according to the plan.

There are also challenges to meet the demands for emergency placements within the available budget allocations.

“Demographic changes over the next 12 months will result in almost 20,000 more people aged 65 and over, and approximately 6,000 more people living with a disability, with increasing levels of dependency,” the plan states.

“Capacity to meet the needs of this cohort will present a significant challenge, including meeting the demand for residential and respite services and the provision of emergency places for people with a disability.”

Another risk is providing residential services for older persons within the available funding due to increasing staff costs, delivering services in buildings, reliance on agency staffing to maintain roster arrangements and a lack of progress on having an agreed framework for staffing and skill-mix to provide these services.

“Meeting the demand for older persons’ home supports, and particularly the increasing demands to support discharges of patients from acute hospitals to home, remains a challenge and where the workforce requirement for these services is not increasing at the required level,” according to the plan.

“This increased demand is also being met where there has been an increase in the costs of delivering home supports due to the level of complexity of those requiring the service, as well as the provision of the service on an out-of-hours basis. Any further increases in cost could curtail the planned level of service to be provided.”

Overall, the plan states that the growing cost of delivering core services is such that the HSE and community healthcare services will face a very significant financial challenge in 2018 in maintaining the existing level of overall activity.

“In mitigating this challenge, we are conscious that maintaining services and driving improvements in patient safety and quality remain the overriding priorities across the health sector, and all savings and efficiency measures will be assessed with these priorities in mind,” according to the plan.