IMO advocating for investment in health service capacity

Through numerous submissions, meetings with members of the Oireachtas and countless media statements and interviews, the IMO has been flagging the actions needed to address the huge capacity deficits across our health system.

In order to ensure the future sustainability of the healthcare system, the IMO continues to call on the Department of Health and the HSE to agree a strategy with the IMO for the development of general practice in Ireland over the coming decade. An extensive body of international research shows that continuity of care and the patient-centred approach that is specific to general practice are associated with better health outcomes, equity of access, reduced inequalities in health, more appropriate utilisation of services, and long-term cost-effectiveness. However, FEMPI cuts have seen a dramatic reduction in the level of resources allocated per person to general practice and there is an imminent shortage of GPs.

In addition to investing in general practice, the IMO is also calling for increased funding for health and wellbeing. Prioritising disease prevention, health promotion and public health services has been highlighted by the World Health Organisation as a key action to ensure the economic, social and environmental sustainability of healthcare systems.

Investment in general practice will not solve the crisis in our emergency departments but it will reduce the rate of increase in demand on the hospital system. However, it must be realised that an expanding and ageing population will create additional demand for hospital capacity. Currently, our hospitals operate at above full capacity, with unprecedented overcrowding and hospital waiting lists. The IMO is calling for urgent investment in acute bed capacity and that hospitals operate at an average of 85 per cent bed occupancy rates to ensure patient safety and provide for seasonal surges in demand. Hospital planning must also include an assessment of diagnostics, radiology and laboratory service requirements in both the hospital and community settings, as well as the human and financial resources required for the continuous and adequate delivery of services.

Capacity within the acute hospital system can be used more effectively, with the immediate reinstatement of the 1,500 inpatient beds removed from the system since 2007 and the full implementation and resourcing of national clinical programmes and models of care, such as the National Clinical Programme in Surgery and the National Model of Care for Trauma and Orthopaedic Surgery.

With Ireland’s ageing population, the IMO is also highlighting the need to ensure appropriate provision of long-term care (residential and community), rehabilitative and palliative care, as well as the resourcing of extended care services in the community, to ensure that our elderly receive the necessary social care and do not remain in hospital longer than necessary.

In January this year, the Department of Health published the long-awaited Health Service Capacity Review, which made clear that to meet our future healthcare needs, investment is needed in tandem across the health services, including GP services, long-term and community care and acute hospital beds.

The Health Service Capacity Review estimates that, without reform, by 2031 the health service will require 1,400 additional GPs and 500 additional practice nurses, as well as other additional healthcare services and supports in the community. In relation to social care for the elderly, without reform, an additional 10,100 long-term residential care beds and 1,800 short-term beds are required. Over 11,000 home care packages will be required, as well as 7.2 million additional home help hours. If the current model of healthcare continues, Ireland will require an additional 7,150 public hospital beds, including 5,800 inpatient beds, to meet a target of 85 per cent bed occupancy rates.

However, if a full range of reform measures are implemented — including the implementation of Healthy Ireland, an improved model of care centred around comprehensive community-based services and the continued reconfiguration of hospital services and improvements to patient flow — the estimated capacity requirements will be 1,030 additional GPs, 1,200 additional practice nurses and further additional community healthcare services. Fifteen-thousand long-term and 2,500 short-term residential care beds will be required for the elderly, as well as over 19,000 home care packages and 12.5 million home help hours. With all reform measures implemented, the number of acute beds required would be substantially reduced to an additional 2,590 beds, including 2,100 inpatient beds.

Given the enormous investment that is required, it is likely that the requirements will fall somewhere in the middle. Given the dangerous occupancy rates within our hospitals and growing hospital waiting lists, it is important that investment is accelerated and that the Review does not get left on the shelf. The hospital beds will also need to be staffed and unfortunately, the Review did not address the unprecedented crisis in recruitment and retention of consultant and non-consultant hospital doctors in our acute hospital services.

As the representative body for all doctors in Ireland, the IMO is committed to the development of a caring, efficient and effective health service and continues to advocate for accelerated investment in capacity and medical manpower across the health system.

Dr Ann Hogan is IMO President.